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Root Cause Analysis Checklist
Section 1: Root Cause Analysis Checklist
1. 1. Is Initial data collected?
Yes
No
N/A
2. 2. Is information about management systems collected?
Yes
No
N/A
3. 3. Is information regarding physical controls collected?
Yes
No
N/A
4. 4. Is information regarding behaviors collected?
Yes
No
N/A
5. 5. Is the worksite examined?
Yes
No
N/A
6. 6. Are personnel involved identified?
Yes
No
N/A
7. 7. Is the equipment involved identified?
Yes
No
N/A
8. 8. Are staff/witnesses interviewed?
Yes
No
N/A
9. 9. Is documentation examined?
Yes
No
N/A
10. 10. Are training records examined?
Yes
No
N/A
11. 11. Are health & safety inspection reports examined?
Yes
No
N/A
12. 12. Are any required tests conducted?
Yes
No
N/A
13. 13. Are the events depicted using the five "W's" (who, what, why, where, when)?
Yes
No
N/A
14. 14. What are the causal factors?
15. 15. What is the Factual Evidence?