Title Page

  • Company

  • Location
  • RCA Team Leader

  • Conducted on

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

  • 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


  • Full Name and Signature of RCA Team Leader

  • List RCA Team Members

  • Full Name and Signature

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