Title Page

  • Location

  • RCA Conducted By

  • Conducted on

Investigation Findings

Issue Details

  • Date issue reported.

  • Is this a recurring issue?

  • What is the frequency of the issue?

  • In which department was the issue identified?

  • Brief description of the issue.

  • Rate the impact to productivity.

  • 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?

  • Were any interviews conducted?

  • Give a brief summary of the interview.

  • Who was interviewed about the issue?

  • Were any processes audited?

  • Which process was audited?

  • List any findings pertinent to the investigation.

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

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

  • Take photographs of any evidence when applicable.

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

  • Categorize the root cause of the issue.

  • 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?

  • List the special considerations.

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

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


  • Date of Completion

  • Full Name and Signature of Investigator

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