Root Cause Analysis / Corrective Action

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Equipment Identification

Equipment Serial Number or Asset ID*

For traceability and equipment history

Equipment Type*

Equipment Make and Model*

Equipment Age*

Approximate Years in Service

Installed Location*

Plant/Facility Area

Equipment Usage

If known; useful for wear/fatigue analysis

Usage Amount

Hours, miles, or kilometers as selected prior

Failure Event Information

Date of First Symptom or Failure Event*

Exact Time of Failure

If known; correlate with shift, load changes, etc

Operator on Duty / Shift*

To identify human interaction and procedural context

Load or Duty Cycle at Time of Failure*

e.g., full load, low load, startup

What was the impact of the failure?*

Was the equipment running, starting, stopping, or idle when symptoms first appeared?*

Describe the Symptoms Observed*

Was the failure sudden or progressive over time?*

Any Alarms, Warnings, or System Logs Noted?*

Instrumented feedback or logs may be available

Was the failure repeatable (occurred before)?*

Has similar equipment at your site experienced similar issues?*

Environmental Conditions

Describe any ambient conditions*

Temperature, humidity, contaminants, exposure to chemicals, weather if outdoors

Was the equipment exposed to abnormal operating conditions?*

Nearby Equipment or Processes That May Influence Conditions*

e.g., furnaces, cooling towers, high-vibration machines

Changes in Environmental Conditions in the Last 30 Days*

e.g., seasonal, construction, chemical usage

Maintenance and Repair History

Date of Last Scheduled Maintenance*

Type of Maintenance Recently Performed (PM, Repair, Overhaul)*

Was maintenance performed by in-house staff or third-party contractors?*

Were maintenance records or logs reviewed prior to this failure?*

Were there any recent parts replacements or upgrades?*

Was any corrective action recently delayed or deferred?*

Lubricants or Consumables Used*

Type, brand, change frequency. Very useful for mechanical failures

Failure Analysis and Response

Was any analysis already performed?*

e.g., vibration, oil analysis, thermal imaging

Were any parts retained for analysis?*

Are photos of the failure or symptoms available?*

Yes

Upload up to three photos (if possible)

Drop files here or

Accepted file types: jpg, png, jpeg, Max. file size: 16 MB, Max. files: 3.

Have any immediate corrective actions already been taken?*

Containment, repair, bypass

Additional Documentation

Please upload up to 5 pictures or any pdf reports that will help in the analysis and corrective action report

Drop files here or

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 32 MB, Max. files: 5.

Oil analysis, vibration analysis, thermal analysis Thermography, ultrasonic, motor current, or x-ray analysis

Report Summary

Please summarize any findings in attached reports, if available

Risk and Criticality Assessment

How critical is this equipment to operations?

Did this failure cause a safety incident or near miss?

Estimated Financial Impact

Downtime, repairs, lost production

Contact Information and Terms

Company*

Name*

First Last

Job Title or Role*

Email*

Phone Number

Company Address

I have authority to provide this information and request analysis

I consent to the storage and analysis of this data by Lancer Analytic of 5th Order Industry Inc.

I agree to the terms

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Comments

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