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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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
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.
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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.
