1. Master Forms MODULE 8 Use the forms in this section as MASTERS.
Copy them for use whenever performing the root cause analysis and corrective action process.
Module 8
page 1

2. RCAR Master Form INSTRUCTIONS
This form is based on the form used in the RCAR database. Use it as a working form for your team.
1. RCAR Number - This is the RCAR number that defines the type of RCAR you are working on. The complete number is provided by the RCAR database when the RCAR is first entered.
2. Team Members - List the names of the natural and qualified team members. The RCAR owner will show up as a team member.
3. Description of the event - Describe the event that led to the request for corrective action. If it is a survey finding, repeat the finding here. If it was a product defect or failure analysis, enter the defect description here.
4. Event question - A question, beginning with “WHY”, that states exactly what problem is being analyzed. The event question states the problem taken from the event in the simplest possible terms.
5. Direct cause - The cause that directly lead to the event. The answer to the event question.
6. Contributing Causes - The cause(s) that contributed to an event. The causes after the direct cause.
7. Root Cause - The fundamental reason for an event. The last cause in the chain.
8. Specific Corrective Action - Enter the action(s) taken to correct the direct cause and the effect. Include who is responsible and when the actions are to be, or were, done.
9. Preventive Corrective Action - Enter the action(s) taken against the root and contributing causes to prevent the recurrence of the event. Include who is responsible and when the actions are to be, or were, done.

3. RCCA Workshop Page 1 of 2

4. RCCA Workshop Page 2 of 2

5. RCCA Workshop

6. RCCA Workshop

7. Attach Cause Chain Diagram
RCA - Draft Form