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Root-Cause Analysis Template
Root-Cause Analysis Template
SafetyCulture Staff

Root-cause Analysis Template Checklist

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.

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Free Root-Cause Analysis Template Checklist

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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
  • 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?

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
SafetyCulture Staff

Root-Cause Analysis Template

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.

Use this Digital Checklist
Download as PDF
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.

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