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Root Cause Analysis Template

5 Whys analysis, fishbone diagram, corrective actions and verification

Company
logo

PAGE 1 OF 2

Incident / Problem Details
Investigation Team
# Name Position / Role Department
1
2
3
4
Problem Statement
Sequence of Events
Date / Time Event Description Source / Evidence
5 Whys Analysis
Why Question Answer (supported by evidence)
1Why did the incident / problem occur?
2Why did that happen?
3Why did that happen?
4Why did that happen?
5Why did that happen?

Fishbone (Ishikawa) Diagram - Contributing Factors

People

Process

Equipment

Materials

Environment

Management

Root Cause Determination

Root Cause Analysis Template

Corrective actions, preventive actions and verification

Company
logo

PAGE 2 OF 2

Corrective Actions
# Corrective Action Priority Assigned To Target Date Completed
1
2
3
4
5
6
Preventive Actions
# Preventive Action (to avoid recurrence in other areas) Assigned To Target Date Completed
1
2
3
Verification of Effectiveness
Declaration and Sign-Off

I confirm that this root cause analysis was conducted in accordance with the organisation investigation procedure. The findings recorded above are based on objective evidence gathered during the investigation. Corrective and preventive actions have been agreed with the relevant action owners and target completion dates have been set.

Investigation Lead
Area / Operations Manager
Safety / Quality Manager