Template

Root Cause Analysis (RCA) Template for Safety

by Gavin Moses, from the Community

Apply this Root Cause Analysis template to conduct thorough SHE incident investigations. Capture incident details, witnesses, and RIDDOR reporting status, then assess contributing factors across people, plant and equipment, work environment, and external conditions. Verify training, PPE, signage, and safe systems of work. Collect sketches and photo evidence, document underlying and root causes, and record corrective and preventive actions. Conclude with investigator details, digital signatures, and dates to ensure accountability and continuous improvement.

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Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Incident Investigation & Root Cause Analysis
Use this incident investigation and root cause analysis template to document incident details, classify type and location, record contributing behaviors and conditions, and perform Heinrich quick analysis. Guide your team through 5 Whys and fishbone categories (People, Machine, Method, Materials, Environment, Measurement) to identify root causes, then define corrective actions, PPE, training, and safety coaching with evidence photos to prevent recurrence.
by Jerome Stevenson, from the Community
Downloads: 20+
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Template
Root Cause Analysis (RCA) Template
Use this Root Cause Analysis (RCA) template to document an incident or recurring problem, capture its impact, list possible causes, and identify the true root cause. Add photos as evidence, categorize causes (equipment, process, organization, environment, communication, information, non-conformance), and outline corrective and preventive actions with estimated costs. Record special considerations and incidental findings, then finalize with digital signatures from the RCA lead and team.
by Dilpreet Kanwal, from the Community
Downloads: 10+
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Template
E-3 Root Cause Analysis Report Template
Use this E-3 Root Cause Analysis report template to investigate project failures and adverse events. Capture event details, deviations from standard procedures, contributing human, equipment, training, staffing, communication, environmental, and organizational factors, and document the confirmed root cause. Plan risk reduction and prevention strategies, record PM-only incidental findings, and gather required approvals and signatures. Designed for telecom and installation projects, this customizable RCA form supports consistent documentation and continuous improvement.
by Jason Tello, from the Community
Downloads: 0
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Template
Root Cause Analysis (RCA)
The Root Cause Analysis (RCA) checklist is designed to help organizations identify and address the underlying causes of problems or incidents. It provides a structured approach to analyze failures, implement corrective actions, and prevent recurrence.
by SafetyCulture
Downloads: 300+
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Root Cause Analysis (RCA) Template for Safety

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Incident Investigation & Root Cause Analysis

Root Cause Analysis (RCA) Template

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Root Cause Analysis (RCA)

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Incident Investigation & Root Cause Analysis

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Root Cause Analysis (RCA)