Root-cause Analysis Template Checklist

Print as pdf

SafetyCulture Staff

771 Downloads

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.

GO DIGITAL TODAY
Convert your paper checklists into digital forms

Scan this QR code to use this paper checklist on your smartphone or tablet. Visit www.iauditor.com

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

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

Prevention Strategy

Solution to be implemented

Estimated cost

Are there special considerations?

Are there incidental findings to be reviewed for corrective action?

Completion

Full Name and Signature of RCA Team Leader

List RCA Team Members

MEMBER

Full Name and Signature

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.

Root-cause Analysis Template Checklist

Enter your details to print your FREE checklist

Still haven't found the checklists you were looking for?