Root-Cause Investigation

• Location

  Select Lebanon, TN Torrance, CA

  • Lebanon, TN
  • Torrance, CA

• RCA Conducted By

• Conducted on

  Date

Issue Details

• Date issue reported.

  Date

• Is this a recurring issue?

  Yes

  No

• What is the frequency of the issue?

  Daily

  Weekly

  Monthly

  At Random

• In which department was the issue identified?

• Brief description of the issue.

• Rate the impact to productivity.

  Low

  Medium

  High

• Describe the impact to productivity.

• Describe the impact to productivity.

Root Cause Investigation & Findings

Begin with the department listed above and follow the trail of evidence until the root cause of the issue is identified.

• Investigation Area

Investigation Area

• In which area did the investigation begin?

  Select Sales Controls Engineering Drafting Purchasing Kitting/Warehouse Production Shipping Vessel Dept. Quality Safety ISO Service Accounting

  • Sales
  • Controls
  • Engineering
  • Drafting
  • Purchasing
  • Kitting/Warehouse
  • Production
  • Shipping
  • Vessel Dept.
  • Quality
  • Safety
  • ISO
  • Service
  • Accounting

• Were any interviews conducted?

  Yes

  No

  N/A

• Give a brief summary of the interview.

• Who was interviewed about the issue?

• Were any processes audited?

  Yes

  No

  N/A

• Which process was audited?

• List any findings pertinent to the investigation.

• Was any evidence available that helped determine the root cause?

  Yes

  No

  N/A

• List the items documented as evidence of the root cause.

• Take photographs of any evidence when applicable.

  Media

• Rate the probability that the root cause stems from this area.

  Likely

  Contributing Factor

  Not Likely

• Categorize the root cause of the issue.

  Select Equipment Issues Process Issues Organizational Structure Environmental Factors Lack of Communication Incorrect Information Non-Conforming Product Other

  • Equipment Issues
  • Process Issues
  • Organizational Structure
  • Environmental Factors
  • Lack of Communication
  • Incorrect Information
  • Non-Conforming Product
  • Other

• Please specify.

• Document NCR Number

• Describe the equipment and the issue.

• Identify the process and describe the issue.

• Describe how the organizations structure relates to the root cause of the issue.

• What environmental factors contributed to the root cause of the issue?

• Describe where the lack of communication occurred and how it contributed to the root cause of the issue.

• Describe what information was not correct and how it contributed to the root cause of the issue.

• Summarize the findings of the investigation.

Prevention Strategy

• Solution to be implemented.

• Estimated cost.

• Are there any special considerations?

  Yes

  No

• List the special considerations.

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

  Yes

  No

• List all findings that require corrective action in the action section above.

Completion

• Date of Completion

  Date

• Full Name and Signature of Investigator

  Sign