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Root Cause Analysis Template

This document provides a template for conducting a root cause analysis with 3 steps: 1) Define the problem by describing what happened, when, where, and the impact. 2) Analyze the problem through a cause map identifying effects, causes and evidence. 3) Propose solutions by listing corrective actions that address each identified cause along with the action owner, due date, and verification.

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romee
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225 views

Root Cause Analysis Template

This document provides a template for conducting a root cause analysis with 3 steps: 1) Define the problem by describing what happened, when, where, and the impact. 2) Analyze the problem through a cause map identifying effects, causes and evidence. 3) Propose solutions by listing corrective actions that address each identified cause along with the action owner, due date, and verification.

Uploaded by

romee
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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Step 1: Define the Problem Or, Click Here to Create Your Root Cause Analysis in Smartsheet

What Problem (s)

When Date

Time

Where Facility, site,

Unit, area, equipment

Task being performed

Impact to the Goals


Safety

Environmental

Customer Services

Regulatory

Production / Schedule

Property / Equipment

Labor / Time

Total this incident $ -

Frequency

Annualized Cost $ -
Step 2: Analysis
Why?
Possible Solution:
[Incident Title] Effect Cause

Evidence:
Cause Map Basic Cause-and-Effect Relationship

Why? Why? Why? Why? Why?

Goal Impacted

Safety Goal
Impacted

Environmental
Goal Impacted

Customer Service
Goal Impacted

Regulatory Goal
Impacted

Production /
Schedule Goal
Impacted

Property /
Equipment Goal
Impacted

Labor / Time Goal


Impacted
Step 3: Solutions
[Incident Title]
Corrective Actions - One action (solution) per every cause from the Cause Map

Status - Verification (Check


No. Action Item Cause Owner(s) (Names) Date Due Notes
Completed whether effective)

1
2
3
4
5
6
7
8
9
10

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