Root-Cause Analysis Template

• Company

• Location
  Address

• RCA Team Leader

• Conducted on

  Date

Root-Cause Analysis

Issue Details

• Date issue reported

  Date

• Brief description of the issue

• Rate the impact to productivity

  Low

  Medium

  High

Possible Root Cause

• List potential reasons why the issue happened

CAUSE

• Brief description of a cause

• Rate probability as the root cause

  High

  Medium

  Low

• What is the root cause of the issue?

• Categorize the root cause of the issue

  Select Equipment Process Organization Environment Lack of communication Incorrect information Non-conformance Other

  • Equipment
  • Process
  • Organization
  • Environment
  • Lack of communication
  • Incorrect information
  • Non-conformance
  • Other

• Please specify

Prevention Strategy

• Solution to be implemented

• Estimated cost

• Are there special considerations?

  Yes

  No

• Please specify

• Are there incidental findings to be reviewed for corrective action?

  Yes

  No

• Please specify

Completion

• Full Name and Signature of RCA Team Leader

  Sign

• List RCA Team Members

MEMBER

• Full Name and Signature

  Sign