Root Cause Analysis (RCA) Report

Project Title: Project Location: Date: Prepared By:

1. Problem Statement

2. Incident Description

3. Impact Assessment

4. Immediate Actions Taken

5. Root Cause Analysis

Contributing Factor	Description	Evidence

6. Root Cause(s) Identified

7. Corrective and Preventive Actions

Action	Responsible Person	Target Date	Status

8. Lessons Learned / Recommendations

9. Review & Approval

Reviewed By: Approval: Date: