Laboratory Error RCA Report
Date of Report
Reported By
Department / Unit
Error Date & Time
Error Description
Type of Error
Sample/Patient ID
Error Details
Detection Method
Immediate Actions Taken
Describe Immediate Correction
Root Cause Analysis (RCA)
Contributing Factors
Root Cause(s) Identified
Corrective and Preventive Actions
Actions to Prevent Recurrence
Responsible Person(s)
Follow-up Date
Additional Comments