Root Cause Analysis / Corrective Action

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Problem Identification

What exactly failed or went wrong?*

When was the failure first detected?*

What are the consequences of the failure?*

Downtime, quality, safety, environmental impact

Is this a recurring issue or the first known occurrence?*

Was this failure anticipated in any risk assessments (FMEA, HAZOP, RCM)?*

Equipment and Asset Performance

What equipment, machine, or process was involved?*

Was the equipment running within rated parameters?*

Load, pressure, speed, temperature

Were there recent changes in operation?*

New loads, speeds, recipes, control logic

What is the age and maintenance history of the asset?*

Human Factors

Who was operating, maintaining, or supervising the system at the time of failure?*

Were they trained, certified, or qualified for the task?*

Were there any deviations from standard operating procedures (SOPs)?*

Were there any signs of fatigue, stress, distraction, or human error?*

Process and Procedures

Was a formal procedure or work instruction in place?*

Was the procedure followed precisely?*

Have there been recent changes to process documents or work instructions?*

Were steps skipped, misinterpreted, or performed out of sequence?*

Maintenance and Reliability Practices

Was preventive or predictive maintenance up to date?*

Were there signs of pending failure?*

Noise, vibration, leaks, alarms

Were there outstanding work orders, overdue inspections, or skipped lubrication points?*

Has this failure mode been documented before?*

Monitoring and Control Systems

Were monitoring systems (sensors, alarms, SCADA) functioning and configured correctly?*

Was the fault detected automatically or manually?*

Were alarms ignored, silenced, or missed?*

Was control logic or software recently updated or modified?*

Material and Supply Inputs

Were all raw materials, fuels, or process chemicals in specification?*

Were inputs contaminated, misidentified, or degraded?*

Were supply lines or flow systems obstructed, leaking, or fluctuating?*

Any recent changes in supplier, batch, or storage practices?*

Environmental and External Conditions

Did temperature, humidity, dust, or other environmental factors contribute?*

Was there a weather event near the time of failure?*

Freeze, flood, storm

Were power, steam, air, or water utilities stable and available?*

Any external disturbances?*

Construction, vibration, interference

Change Management and Modifications

Was there any recent change to design, layout, controls, staffing, vendors, or materials*

Was a Management of Change (MOC) process followed?*

Were risk assessments conducted prior to changes?*

Did bypasses, overrides, or temporary workarounds contribute?*

Documentation and Traceability

Are there logs, inspection reports, or historian data available?*

Were deviation reports or incident logs completed and reviewed?*

Are there records of prior similar failures?*

Was anything undocumented, misrecorded, or falsified?*

Communication and Supervision

Were operators or supervisors properly informed of risks or changes?*

Were communication channels between shifts or departments effective?*

Did anyone report an issue before the failure that was not acted upon?*

Contact Information and Terms

Company*

Name*

First Last

Job Title or Role*

Email*

Phone Number

Company Address

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