8/11/2019 4D1D21 Root Cause Analysis Report Sample Template

1/4

Company Logo(optional) Company Name Confidential Document Version Page No

Title(Title must cover the subject on which the root cause analysis is done)

Author NameIncident Reference No (if any)

Executive Summary

This section is to summarize the main report with the below information

!rief description of the problem"situation"incident Problem"situation"incident date Problem"situation"incident type Le#el or se#erity of the problem"situation"incident !rief about the in#estigation methods !rief about the root causes !rief about the recommendations

!roblem"situation"Incident #escri$tion

This section co#ers the detailed e$planation of the problem identified along with the following information

Problem statement %im& ob'ecti#e of the analysis and the e$pected outcomes ow was the problem"situation"incident came into limelight *ho found the problem"situation"incident !ac+ground and conte$t to the problem"situation"incident Problem"situation"incident date Problem"situation"incident type Le#el or se#erity of the problem"situation"incident The effect on the organization

!roject Team

This section co#ers the information about the team in#ol#ed in the root cause analysis of the problemThis includes those who participated in the assessment& report preparation and the management

No of people in each team Name ,ole"Designation -ualification .unctional departments ,esponsibility

Sco$e of Investi%ation"Assessment

This section co#ers the scope and criticality le#el of the in#estigation or assessment done on the problem

identified

Ty$e of Investi%ation"Assessment

This section co#ers the type of in#estigation " assessment& data " e#idence collection methods and theproblem mapping models

#ata"Evidence &ollection

8/11/2019 4D1D21 Root Cause Analysis Report Sample Template

2/4

Company Logo(optional) Company Name Confidential Document Version Page No

This section gi#es the detailed information on data or e#idences collected in /uantitati#e or /ualitati#emodes This area also co#ers the following

ow the data was collected 0apping the data with the method it was collected(.or e$ample& using a /uestionnaire to collect

information on how many employees are dissatisfied because of the problem ere& /uestionnaire isthe data collection method& the number of employees is the data collected)

*ho collected the data ow the data " e#idences are #alidated Date on which the data was collected Date on which the data was #alidated

&hronolo%y of Incidents

1f the problem is responsible for the order of incidences or situations in the organization& using a table forgi#ing chronological data will be #ery helpful

Sam$le Table

#ate with Time ('se asin%le format here)

Incident"Situation

#ata Analysis ethod

This section co#ers the information about data analysis methods

*hat are all the analysis methods used to analyse data *hy these methods are chosen *hy not some other method not suitable for this analysis *hat are the results

Please pro#ide references here with appropriate statistical e#idences

Root &auses

This section co#ers the information on the root causes identified

*hat are all the root causes identified

8/11/2019 4D1D21 Root Cause Analysis Report Sample Template

3/4

8/11/2019 4D1D21 Root Cause Analysis Report Sample Template

4/4

Company Logo(optional) Company Name Confidential Document Version Page No

+ile Name with the*ersion

,ho made thechan%es-(Name. Role)

,hat are the chan%esmade-

#ate