| Customer & Location | Who has experienced the concern? | Customer reference |
| Supplier & Location | Who supplied the product with the concern? | Supplier Reference |
| Date of concern | 1 Team (Champion underlined) | |
| Part number & description | What part number was affected? What is it? | |
| 2 Concern description | Describe the concern so that it is clear what it is. |
| Containment within 24hrs |
3 Stock check has all of the stock been checked |
5 Evidence
Can it be proved that the produced stock has been checked? How is it identified ? Cut off date/batch no./id. : When is the sorted stock cut off? |
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| Temporary counter measure How will new production be checked before it is shipped to the customer |
5 Evidence
Can it be proved there is an ongoing countermeasure? Eg. visual aid, 100% inspection etc. Cut off date/batch no./id : When is the c/measure cut off? |
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| Investigation within 5 days |
4 Root Cause What was the real cause of this concern? Use 5 why analysis, fishbone diagram etc. |
5 Evidence Can the root cause be proved? Can the concern be repeated (this would prove the root cause) Reason for non-detection Why was the concern not identified? |
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| Corrective action within 5 days |
6 Corrective Action What will be done to stop this concern on this part from happening in the future? Target Date for Completion |
5 Evidence Can the corrective actions be proved? e.g. New working procedures Cut off date/batch no./id. : When was the corrective action introduced? |
Recurrence prevention (within 5 days) |
7 Make the solution standard
Will the lessons learnt be used within the rest of the factory?
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5 Evidence Can these predictive actions be proved? Eg. New stage drawings Cut off date/batch no./id. : When were these actions introduced |
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FMEA reviewed :
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| Actions completed (sign and print name) |
Date completed |