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Inspection

Root-Cause Analysis
Issue Details
Date issue reported

Brief description of the issue

Rate the impact to productivity

Possible Root Cause

List potential reasons why the issue happened

CAUSE

Brief description of a cause

Rate probability as the root cause

What is the root cause of the issue?

Categorize the root cause of the issue

Please specify

Prevention Strategy

Solution to be implemented

Estimated cost

Are there special considerations?

Please specify

Are there incidental findings to be reviewed for corrective action?

Please specify

Completion
Full Name and Signature of RCA Team Leader

List RCA Team Members

MEMBER
Full Name and Signature

Root-cause Analysis Template Checklist

Created by: SafetyCulture Staff | Industry: General | Downloads: 157

Use this root-cause analysis template to analyze a recurring problem and help eliminate the root causes. Begin by describing the issue and its impact. Next, list potential reasons why the issue happened and identify the root cause and take/attach photo evidence for verification. Provide a prevention strategy and recommend solutions before completing the RCA template with digital signatures.

Signup for a free iAuditor account to download and edit this checklist. It will be added to your free account and you will be able to conduct inspections from your mobile device.

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Inspection

Root-Cause Analysis
Issue Details
Date issue reported

Brief description of the issue

Rate the impact to productivity

Possible Root Cause

List potential reasons why the issue happened

CAUSE

Brief description of a cause

Rate probability as the root cause

What is the root cause of the issue?

Categorize the root cause of the issue

Please specify

Prevention Strategy

Solution to be implemented

Estimated cost

Are there special considerations?

Please specify

Are there incidental findings to be reviewed for corrective action?

Please specify

Completion
Full Name and Signature of RCA Team Leader

List RCA Team Members

MEMBER
Full Name and Signature