FMEA Form v3.

FMEA

Process/Product Name: Prepared By:

Responsible: FMEA Date (Orig.): (Rev.):

Potential Failure Potential Failure

OCCURRENCE (1 - 10)

OCCURRENCE (1 - 10)
Process Step/Input Potential Causes Current Controls Action Recommended Resp. Actions Taken

DETECTION (1 - 10)

DETECTION (1 - 10)
Mode Effects
SEVERITY (1 - 10)

SEVERITY (1 - 10)
RPN

RPN
What are the
What is the impact on What causes the step,
What is the process In what ways could What controls exist that recommended actions for Who is responsible for What actions were
the customer if this change or feature to go
step, change or feature the step, change or either prevent or detect reducing the occurrence of making sure the actions completed (and when) with
failure is not prevented wrong? (how could it
under investigation? feature go wrong? the failure? the cause or improving are completed? respect to the RPN?
or corrected? occur?)
detection?

Fill carafe with Wrong amount Coffee too Faded level marks Visual Inspection Replace old carafes Mel Carafe replaced
water of water strong or weak 8 on carafe 4 4 128 9/15 8 1 3 24

0 0

0 0

0 0

0 0

0 0

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 FMEA Form v3.7

FMEA

Process/Product Name: Coffee Process Prepared By: Tracy

Responsible: Servers FMEA Date (Orig.): May 15th (Rev.): May 30th

Potential
Process Potential Potential Current Action
Failure Resp. Actions Taken

OCCURRENCE (1 - 10)
Step/Input Failure Mode Causes Controls Recommended

DETECTION (1 - 10)
Effects

SEVERITY (1 - 10)

SEVERITY (1 - 10)
What are the

RPN
What is the Who is
What controls recommended
What is the In what ways impact on the What causes the responsible
exist that either actions for reducing What actions were completed
process step or could the step or customer if this step or feature to go for making
prevent or the occurrence of (and when) with respect to
feature under feature go failure is not wrong? (how could sure the
detect the the cause or the RPN?
investigation? wrong? prevented or it occur?) actions are
failure? improving
corrected? completed?
detection?

Fill carafe Wrong Coffee too Faded level Visual Replace old Mel Carafe replaced 9/15
with water amount of strong or 8 marks on carafe 4 Inspection 4 128 carafes 8
water weak

Water spilled None Train Flo Trained on 9/20

8 from carafe 5 9 360 employees 8

Water too Coffee too Faucet not Finger Train Flo Trained on 9/20
warm strong 8 allowed to run 8 4 256 employees 8
cool

Employee None Train Flo Trained on 9/20

unaware of employees
8 7 7 392 8
need for cool
water
Unclean Foreign Carafe not Visual Appoint Alice Vera appointed 9/21
carafe objects in 10 washed 4 Inspection 4 160 inspector 10
coffee before storage

Bad tasting Carafe stored Training Create storage Alice Bin & visual
coffee 10 improperly 7 5 350 & instructions instructions done 9/25 10

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 FMEA Form v3.7

FMEA

OCCURRENCE (1 - 10)

DETECTION (1 - 10)

RPN
1 3 24

2 7 112

2 6 96

1 8 64

1 4 40

2 3 60

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 FMEA Form v3.7

FMEA

Process/Product Name: Food Order Delivery Prepared By: Team Lead

Responsible: Manager FMEA Date (Orig.): May 1st (Rev.): May 5th

Potential
Process Potential Potential Current Action Actions
Failure Resp.

OCCURRENCE (1 - 10)

OCCURRENCE (1 - 10)
Step/Input Failure Mode Causes Controls Recommended Taken

DETECTION (1 - 10)

DETECTION (1 - 10)
Effects

SEVERITY (1 - 10)

SEVERITY (1 - 10)
What are the

RPN
What is the Who is
What causes What controls recommended What actions
What is the In what ways impact on the responsible
the step or exist that either actions for reducing were completed
process step or could the step or customer if this for making
feature to go prevent or the occurrence of (and when) with
feature under feature go failure is not sure the
wrong? (how detect the the cause or respect to the
investigation? wrong? prevented or actions are
could it occur?) failure? improving RPN?
corrected? completed?
detection?

Changing Run out of Unable to Supply chain Won't know Give vendor a Manager Directions
Vendors key food offer issues until delivery 30-day trial created,
products standard copied and
menu items 8 8 10 640 distributed 8 6 10
on May 5th

Delivering to Won't know Have vendor Manager Instituted on

others first until delivery call to confirm May 5th
8 8 10 640 quantities 8 4 10

Impose Manager Instituted on

8 8 10 640 penalties for May 6 8 4 10
missed items

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 FMEA Form v3.7

Products Customers The vendor Won't know Conduct taste Chef Setup testing
may differ reject the has found until tests on any trials on May
from what's new cheaper customers new brands of 5th
currently products sources taste new products -
served 10 9 product 10 900 reject as 10 4 10
needed

Vendor Won't know Have vendor Manager Contact

delivers best until replace any vendor as
food to long- customers products that needed on
10 term 7 taste new 10 700 don't meet May 6 8 4 10
customers product requirements

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 FMEA Form v3.7

FMEA

RPN
480

320

320

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 FMEA Form v3.7

400

320

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 FMEA Form v3.7

FMEA

Process/Product Name: Establishing Stocking Levels Prepared By: Team

Responsible: Wesley FMEA Date (Orig.): 25-May (Rev.):

Potential
Process Potential Potential Current Action Actions
Failure Resp.

OCCURRENCE (1 - 10)

OCCURRENCE (1 - 10)
Step/Input Failure Mode Causes Controls Recommended Taken

DETECTION (1 - 10)

DETECTION (1 - 10)
Effects
SEVERITY (1 - 10)

SEVERITY (1 - 10)
What are the

RPN
What is the Who is What are the
What causes What controls recommended
What is the In what ways impact on the responsible completed
the step or exist that either actions for reducing
process step or could the step or customer if this for making action taken
feature to go prevent or the occurrence of
feature under feature go failure is not sure the with the
wrong? (how detect the the cause or
investigation? wrong? prevented or actions are recalculated
could it occur?) failure? improving
corrected? completed? RPN?
detection?

Chef to put Chef gets Delay of all 10 It takes too 10 White Board 4 400 Cross-Train all Scott 27-May 10 7 1
food into backed up food orders much time to showing kitchen staff to
containers with orders package food order handle pick-up
orders timing packaging

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 FMEA Form v3.7

FMEA

RPN
70

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 Risk Management

Process/Product Name: Production Prepared By:

Responsible: Marquis FMEA Date (Orig.):

OCCURRENCE (1 - 10)
Process Potential Failure Potential Failure
Potential Causes Current Controls

DETECTION (1 - 10)
SEVERITY (1 - 10)
Step/Input Mode Effects

RPN
What is the What is the impact
What causes the step,
process step, In what ways could on the customer if What controls exist that
change or feature to go
change or feature the step, change or this failure is not either prevent or detect
wrong? (how could it
under feature go wrong? prevented or the failure?
occur?)
investigation? corrected?

Material advances Handling materials after Inspection by material

Extrusion Bent material in process without 6 extrusion, placing materials 7 handling and subsequent 5 210
being reworked on racks. departments

Transport
Scratched material Material advances Moving Materials from Inspection by material
materials from
or Damaged in process without 6 Extrusion to warehouse 8 handling and subsequent 5 240
Extrusion to
material being reworked and then back to Anodizing departments
Anodize

Material advances Handling materials after Inspection by material

Anodization Damaged materials in process without 6 extrusion, placing materials 7 handling and subsequent 5 210
being reworked on racks. departments

Transport Scratched material Material advances Moving Materials from Inspection by material
materials from or Damaged in process without 6 Extrusion to warehouse 8 handling and subsequent 5 240
Anodize to Paint material being reworked and then back to Anodizing departments

Material advances Handling materials after Inspection by material

Paint Damaged materials in process without 6 extrusion, placing materials 6 handling and subsequent 5 180
being reworked on racks. departments

Transport Scratched material Material advances Moving Materials from Inspection by material
materials from or Damaged in process without 6 Extrusion to warehouse 8 handling and subsequent 5 240
Paint to Shipping material being reworked and then back to Anodizing departments
ement

Jeff Owens
10/01/15 (Rev.): 1/15/2016

OCCURRENCE (1 - 10)
Action
Resp. Actions Taken

DETECTION (1 - 10)
SEVERITY (1 - 10)
Recommended

RPN
What are the Who is
recommended actions for responsible for What actions were
reducing the occurrence making sure the completed (and when) with
of the cause or improving actions are respect to the RPN?
detection? completed?

Improve racks design to Constructed new racks.

reduce damage. Improve Installed new lighting.
lighting at inspection Marquis/Whitt Improve operational 6 4 3 72
point. definitions and provided
training

Create new storage area

Constructed new racks.
to reduce travel Jeff 6 2 3 36
Created new storage area.
Improve product tiedowns

Constructed new racks.

Improve racks design to
Installed new lighting.
reduce damage.
Marquis/Whitt Improve operational 6 4 3 72
Improve lighting at
definitions and provided
inspection point.
training

Improve product tiedowns Jeff Constructed new racks 6 2 3 36

Constructed new racks.

Improve racks design to
Installed new lighting.
reduce damage.
Marquis/Whitt Improve operational 6 4 3 72
Improve lighting at
definitions and provided
inspection point.
training

Improve product tiedowns Jeff Constructed new racks 6 2 3 36

 Risk Management

Process/Product Name: Tax Payment Process Prepared By:

Responsible: Jesse, Tax Dept. Head FMEA Date (Orig.):

OCCURRENCE (1 - 10)
Process Potential Failure Potential Failure
Potential Causes Current Controls

DETECTION (1 - 10)
SEVERITY (1 - 10)
Step/Input Mode Effects

RPN
What is the What is the impact
What causes the step,
process step, In what ways could on the customer if What controls exist that
change or feature to go
change or feature the step, change or this failure is not either prevent or detect
wrong? (how could it
under feature go wrong? prevented or the failure?
occur?)
investigation? corrected?

Tax obligation not

Update Mortgage Wrong account/ Wrong Info received by Only visual inspection or
made in a timely 10 2 9 180
information address information Mortgage company next run of tax notices
fashion

Information typed Only visual inspection or

10 2 9 180
incorrectly next run of tax notices

Tax obligation not

Process Tax Only visual inspection or
Incorrect account made in a timely 10 Account improperly entered 2 9 180
Payment next run of tax notices
fashion

Discrepancy in tax Only visual inspection or

Incorrect amount 6 Amount improperly entered 2 9 108
payment next run of tax notices

Tax obligation not Notices get return from

Print/Mail Tax Wrong address Account/address
made in a timely 10 2 Post Office as 4 80
Notices information improperly entered
fashion undeliverable

Arrange for Discrepancy in tax Noted on entering

Amount incorrect 6 Taxpayer error 2 10 120
payment payment payment
ement

Anne
(Rev.):

OCCURRENCE (1 - 10)
Action
Resp. Actions Taken

DETECTION (1 - 10)
SEVERITY (1 - 10)
Recommended

RPN
What are the Who is
recommended actions for responsible for What actions were
reducing the occurrence making sure the completed (and when) with
of the cause or improving actions are respect to the RPN?
detection? completed?
 Risk Management

Process/Product Name: Quality Management Audit Process Prepared By:

Responsible: Kurt Sheppard FMEA Date (Orig.):

OCCURRENCE (1 - 10)
Process Potential Failure Potential Failure
Potential Causes Current Controls

DETECTION (1 - 10)
SEVERITY (1 - 10)
Step/Input Mode Effects

RPN
What is the What is the impact
What causes the step,
process step, In what ways could on the customer if What controls exist that
change or feature to go
change or feature the step, change or this failure is not either prevent or detect
wrong? (how could it
under feature go wrong? prevented or the failure?
occur?)
investigation? corrected?

Open Report and Results of audit not Algorithm for taking sample Only visual inspection of
Bias Sample 9 2 9 162
filter for sample appropriate selected improperly sample after it is selected

Remaining steps cannot

Add sample to Sample not Power blip in computer
Sample not loaded 2 1 be completed if sample 1 2
audit tool available for review area
doesn't load

Remaining steps cannot

Log into EMP and Data not available
Data not saved 6 2 be completed if sample 1 12
enter patient data for review
doesn't load

Only visual inspection of

Incorrect
Data entered Enterer selects wrong information / would
information stored 8 2 7 112
incorrectly persons records appear different from
about patient
history
ement

Lynne
02/15/17 (Rev.):

OCCURRENCE (1 - 10)
Action
Resp. Actions Taken

DETECTION (1 - 10)
SEVERITY (1 - 10)
Recommended

RPN
What are the Who is
recommended actions for responsible for What actions were
reducing the occurrence making sure the completed (and when) with
of the cause or improving actions are respect to the RPN?
detection? completed?
 Severity Scale
Adapt as appropriate

Effect Criteria: Severity of Effect Ranking

Hazardous - May expose client to loss, harm or major disruption -

10
Without Warning failure will occur without warning

Hazardous - May expose client to loss, harm or major disruption -

9
With Warning failure will occur with warning

Major disruption of service involving client interaction, resulting in either

Very High 8
associate re-work or inconvenience to client

Minor disruption of service involving client interaction and resulting in either

High 7
associate re-work or inconvenience to clients

Major disruption of service not involving client interaction and resulting in either
Moderate 6
associate re-work or inconvenience to clients

Minor disruption of service not involving client interaction and resulting in either
Low 5
associate re-work or inconvenience to clients

Minor disruption of service involving client interaction that does not result in
Very Low 4
either associate re-work or inconvenience to clients

Minor disruption of service not involving client interaction and does not result in
Minor 3
either associate re-work or inconvenience to clients

No disruption of service noticed by the client in any capacity and does not result
Very Minor 2
in either associate re-work or inconvenience to clients

None No Effect 1
 Occurrence Scale

Per Item Failure

Probability of Failure Time Period Ranking
Rates

More than once per day >= 1 in 2 10

Very High: Failure is almost inevitable
Once every 3-4 days 1 in 3 9

Once every week 1 in 8 8

High: Generally associated with processes similar to
previous processes that have often failed
Once every month 1in 20 7

Once every 3 months 1 in 80 6

Moderate: Generally associated with processes
similar to previous processes which have
Once every 6 months 1 in 400 5
experienced occasional failures, but not in major
proportions
Once a year 1 in 800 4

Low: Isolated failures associated with similar

Once every 1 - 3 years 1 in 1,500 3
processes

Very Low: Only isolated failures associated with

Once every 3 - 6 years 1 in 3,000 2
almost identical processes

Remote: Failure is unlikely. No failures associated

Once Every 7+ Years 1 in 6000 1
with almost identical processes
 Detection Scale

Criteria: Likelihood the existence of a defect will be detected

Detection by process controls before next or subsequent process, -OR- Ranking
before exposure to a client

Almost Impossible No known controls available to detect failure mode 10

Very remote likelihood current controls will

Very Remote 9
detect failure mode

Remote likelihood current controls will

Remote 8
detect failure mode

Very low likelihood current controls will

Very Low 7
detect failure mode

Low Low likelihood current controls will detect failure mode 6

Moderate likelihood current controls will

Moderate 5
detect failure mode

Moderately high likelihood current controls will

Moderately High 4
detect failure mode

High High likelihood current controls will detect failure mode 3

Very high likelihood current controls will

Very High 2
detect failure mode

Current controls almost certain to detect the failure mode.

Almost Certain Reliable detection controls are known 1
with similar processes.