Root Cause Analysis Report Template

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Root Cause Analysis Report 441295432.docx Version 1.

Gmmco

Root Cause Analysis Report

Table of Contents

1 Overview.............................................................................................................................................................2
2 Issue....................................................................................................................................................................2
3 Root Causes.........................................................................................................................................................3
4 Action Items........................................................................................................................................................3
5 Work Around.......................................................................................................................................................3
6 Solution and Deployment Plan............................................................................................................................3
Root Cause Analysis Report 441295432.docx Version 1.0

1 OVERVIEW

Document Guide

The following template is provided for use with the Root Cause Analysis Report deliverable. The red italic text
provides guidance to the author, and should be deleted before publishing the document.

Where text is intended to be substituted, these areas are formatted as follows: <Text>

Document Use

Follow the IMPROVE Manual Guideline to complete a root cause analysis. Complete one report per analysis
completed (e.g., monthly analysis of exceptions or defects). Use the report to gain consensus on action items,
solutions and deployment plans.

The purpose of this report is to gain consensus among key stakeholders on the analysis, action items,
solutions and deployment plans to prevent the problem from recurring. The Root Cause Analysis Report
records the problem data, analysis and actions to resolve the problem. The key team members and
stakeholders involved in this analysis include:

Provide names of key individuals involved in the root cause analysis. Se example below.
Team members completing the Root Cause Analysis Report:
Name, Title
Name, Title

Managers responsible for approvals:


Name, Title
Name, Title

2 ISSUE
Document the problem for which RCA is prepared. Mention the incident number which is created
for the problem. Include screenshots for the problem if available.

3 ROOT CAUSES
Document the root causes for each problem type selected for analysis.
Root Cause Analysis Report 441295432.docx Version 1.0

4 ACTION ITEMS
Agree upon the action items to be performed to address the root causes. Assign resources and timeframes to
complete the work. Document the expected outcomes. Obtain concurrence from engagement leadership as
needed, before proceeding.
5 WORK AROUND
Document the work around if available

6 SOLUTION AND DEPLOYMENT PLAN


Document both the solution and deployment approach. This section should describe the implementation plan for
the solution. Use this section to document regular status, if appropriate (e.g., document the work plan for
implementation). Revise expected outcomes, as needed. Obtain concurrence from management as needed,
before proceeding.

Revision History

Date Version Description Author


<Date> <Version #> <Description> <Name of Author>

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