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Root Cause Analysis (RCA) Document

Document Statistics

Title
Document Version
Last Date Document was Updated
Document Owner
Document Author
Document Reviewer(s)

Revision History of the RCA

Version No Revision Date Nature of Change


1.0
Root Cause Analysis (RCA) Document Details
Section One

Problem Assigned
Problem Assigned to RCA Completed By:
Team
Incident Number:
Incident Start Incident Resolution
Incident Priority
Date & Time: Date & Time:

Section Two

Incident Summary
Incident Description / Impact / Symptoms:
Description –
Impact –
Symptoms –
Impacted Locations:

CI details:
Host Name :
CI:

Was this a result of a (failed) change? If Change caused the incident – enter Change #

Incident Resolution Summary:

Section Three

Incident Timeline (in Chronological order)


IST and 24:00 clock format
Time Action Taken
Section Four

Root Cause Summary


1.

Section Five

Contributing Factors
1.

Section Six

Status (open/ Target date of


No. Corrective Action Items Action Owner
closed) Completion
1.
2.
3.
4.
5.
6.
Status (open/ Target date of
No. Preventative Action Items Action Owner
closed) Completion

1.

2.
Note - Add additional rows for action items as required

Section Seven

No Lesson Learned

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