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Form to make a root cause analysis a success
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SSON #:
Processus de correction des causes fondamentales - SSON et QN
Root Cause Corrective Action Process - SSON and QNP&WC 10663 (2005-09)
1. SSON No.:2. N de article SSON:
SSON Item No.:3. Date (aaaa-mm-jj / yyyy-mm-dd):
4. QN No.: 5. NB. Tous les champs doivent tre remplis; si non-applicable, entr N/A". Ne laisser aucun champs vierge.
Make entries in ALL fields. If not applicable, write NA. Do NOT leave blank.
6. N de pice:
Part Number:7. Dsignation de la pice:
Part Description:
8. tape PCCF 1: Dcrire et comprendre la situation
RCCA Step 1: Describe and Understand the Situation
9. Description du problme:
Description of Problem:
10. tage o le problme s'est produit:
Stage Where Problem Occurred:
11. Quantit directement vise:
Qty Directly Affected:11A. SNs:
12. Numros des pices semblables possiblement vises:
List Similar Part Numbers Potentially Affected:
13. Mesures de confinement adoptes:
Containment Action(s) Taken
14. tape PCCF 2: Identifier les ressources ncessaires (Personnes / Fonctions)
RCCA Step 2: Identify Responsible Resources: (Individuals / Functions)
15. Personne:
Individual:16. Fonction:
Function:
17. tape PCCF 3: Identifier, slectionner, classer les causes fondamentales probables par priorit
RCCA Step 3: Identify, Select, Prioritize Probable Root Cause(s) voir / see 17.X
18. tape PCCF 4: Valider les causes probables RCCA Step 4: Validate Probable Root Cause(s) voir / see 18.X
19. Liste des mthodes d'analyse utilises:
List of Analysis Methods Used:
Causes fondamentales les plus probables
Most Probable Root Cause
(RCCA tape/Step 3)Responsable de la confirmation de la causeCause confirme?
Cause Confirmed?
Person Responsible for Confirmation of CauseOui/Yes or Non/No
(RCCA tape/Step 4)
17.1
Matriel
Material 18.1
17.2
Mthode
Method 18.2
17.3
Direction
Management 18.3
17.4
Milieu
Environment 18.4
17.5
Mesure
Measurement 18.5
17.6
Main-doeuvre
Manpower 18.6
17.7 Machine
18.7
17.8
Autre
Other 18.8
20. tape PCCF 5: Identifier, slectionner, classer les solutions potentielles par priorit RCCA Step 5: Identify, Select, Prioritize Potential Solution(s) voir / see 20.X
21. tape PCCF 5: Valider les solutions potentielles RCCA Step 6: Validate Potential Solution(s) voir / see 21.X
Solutions potentielles
Potential Solutions
(RCCA tape / Step 5)Responsable de la confirmation de la solutionSolution confirme?Solution Confirmed?
Person Responsible for Confirmation of SolutionOui/Yes or Non/ No
(RCCA tape/ Step 6)
20.1 21.1
20.2 21.2
20.3 21.3
20.4 21.4
20.5 21.5
22. Approuv par (Signature ou signature lectronique):
Approved By (Signature or Electronic Signature):
23.Date:
Nom (caractres imprimerie):Print Name:
24. tape PCCF 7: Mettre en oeuvre le plan daction et surveiller lefficacit des solutions choisies
RCCA Step 7: Implement Action Plan & Monitor Effectiveness of Solutions
25. Solution adopteSelected Solution
26.
tapes majeures de la mise en oeuvre
Major Implementation Steps
27. Responsable
Responsible
28.
Date de la mise en oeuvre
Implementation Date
25.1
25.2
25.3
25.4
25.5
29. Comment et quand sera vrifie lefficacit de la solution?
How and when will the effectiveness of the selected solutions be verified?
29.1 Date:
29.2 Date:
29.3 Date:
29.4 Date:
29.5 Date:
30. Unit de mesure de lefficacit
Effectiveness Monitoring - Metrics
31. 32. Date:
33. tape PCCF 8: Standardiser les processus similaires
RCCA Step 8: Standardize Similar Process
Numros des pices de la cellule 12 pour lesquelles s'appliquent les solutions mises en oeuvre dans l'tape 7 du PCCF, cellules 25.1 25.5
List part numbers identified in cell 12 for which the solutions implemented in RCCA Step 7, cells 25.1 to 25.5 are applicable: Les pices dont les numros suivent sont-elles ZNC?Are these part numbers at ZNC? Oui / Yes: Non / No:
Dans la ngative, quelle mesure doit-on prendre pour que ces pices deviennent ZNC?If no, what actions are required to get these part numbers designated as ZNC?
PCCF approuve par (le titulaire de P&WC) (Signature ou signature lectronique):RCCA Approved By (P&WC Owner) (Signature or Electronic Signature): Date:
Nom (caractres imprimerie):Print Name:
PAGE \# "'Page: '#''" This field applicable when submitting an SSON.
PAGE \# "'Page: '#''" Complete one RCCA form for each SSON item. Insert completed RCCA form as an Object file as ICON in SSON Form 2881.
PAGE \# "'Page: '#''" Date when RCCA started. Use format dd month yryr, eg 12 June 2005
PAGE \# "'Page: '#''" This field applicable when submitting RCCA associated with a QN, following an escape.
PAGE \# "'Page: '#''" State at what stage problem has occurred, eg. Machining of casting, pre-heat treatment, etc
PAGE \# "'Page: '#''" Quantity discrepant under this SSON item or QN
PAGE \# "'Page: '#''" Identify up-front part numbers which could be similarly affected. In RCCA Step 8, you are required to list the part numbers for which the solution(s) selected in RCCA Step 5 have been implemented.
PAGE \# "'Page: '#''" What steps have been taken to segregate other parts with this discrepancy from being shipped? What steps have been taken to ensure compliant parts being shipped prior to the implementation of preventive solution(s) of Step 7
PAGE \# "'Page: '#''" For each of the applicable contributory causes 17.1 to 17.8, list the analysis method used eg. Brainstorming, Whys, Pareto analysis, Design of Experiment, Run Charts etc
PAGE \# "'Page: '#''" List all potential root cause(s) of each contributory cause
PAGE \# "'Page: '#''" Enter Yes for each confirmed root cause. If root cause not confirmed or deemed to be not a cause. Enter No
PAGE \# "'Page: '#''" For each Yes in cells 18.1 to 18.8 list potential solution. State reference number of 18.1 to 18.8
PAGE \# "'Page: '#''" Enter Yes for each confirmed potential solution. If potential solution not confirmed or deemed to be not valid, enter No
PAGE \# "'Page: '#''" Enter each solution reference from 20.1 to 20.5 that is confirmed Yes in cells 21.1 to 21.5
PAGE \# "'Page: '#''" List major activities to implement the solutions confirmed Yes in cells 21.1 to 21.5
PAGE \# "'Page: '#''" Name of individuals responsible for implementing each major step
PAGE \# "'Page: '#''" Enter date when the solution will be fully implemented.
PAGE \# "'Page: '#''" Enter in cells 29.1 to 29.5 how and when the effectiveness of each of the selected solutions in cells 25.1 to 25.5 be verified.
PAGE \# "'Page: '#''" State the metrics in cell 30 that will be used to verify effectiveness of each of the solutions listed in cells 25.1 to 25.5. In cell 31 enter the date when metrics monitoring will start.
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