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FMEA Worksheet

Process Failure Modes and Effects Analysis (FMEA) Worksheet
Critical Element Potential Failure Mode Potential Failure Effects Potential Causes Current Controls
What is the critical element or part? In what ways does this go wrong (fail)? What is the consequence on Performance? What causes or reasons for the loss of performance? What are the existing controls and procedures (inspection and test) that prevent loss of performance?

FMEA Scale

Example

Process or Product Name: Prepared by: Page ____ of ____
Responsible: FMEA Date (Orig) ______________ (Rev) _____________
Process Step Key Process Input Potential Failure Mode Potential Failure Effects SEV Potential Causes OCC Current Controls DET RPN EOC Actions Recommended SEV OCC DET RPN
What is the process step What is the Key Process Input? In what ways does the Key Input go wrong (fail)? What is the consequence on the Key Output Variables (Project Objective)? How Severe is the failure effect to the project objective? What causes the Key Input to go wrong? How often does the cause occur? What are the existing controls and procedures (inspection and test) that prevent the Failure Mode? How well can you detect cause?
Appointment Scheduling Customer Info Inaccurate customer information No Charge 10 Vacant/Not home 4 Confirm Appt 10 400
Appointment Scheduling Customer Info Inaccurate customer information No Charge 10 No Access 5 Confirm Appt 10 500
Appointment Scheduling Customer Info Inaccurate customer information No charge 10 Customer Disputes 4 Review with Supervisor 9 360
Appointment Scheduling Customer Info Inaccurate customer information No Charge 10 Irate Customer 4 Review with Records Department 6 240
Arrive at Location System Operation False Alarm No Charge 10 Charges Waived 7 Review Instructions with Owner 10 700
Arrive at Location System Operation Fails No Charge 10 Fees waived by Supervisor 5 Check Monitoring Signal 9 450
Arrive at Location System Operations Not Funtional/ Faulty No Charge 10 Install Error 5 Training of Technicians 8 400
Billing Electonic Records Improper Information No Charge 10 Form improperly completed 8 Training of Technicians 5 400 Establish Audit 10 2 10 200
Billing Electonic Records Improper Repair Codes No Charge 10 Codes out of date 7 Updates and Versions correct 5 350
Billing Electonic Records Database Errors No Charge 10 Quality Problems 3 Infrequent Inspection 10 300

FMEA Form

Process or Product Name: Prepared by: Page ____ of ____
Responsible: FMEA Date (Orig) ______________ (Rev) _____________
Process Step Critical Input Potential Failure Mode Potential Failure Effects SEV Potential Causes OCC Current Controls DET RPN EOC Actions Recommended Resp. Actions Taken SEV OCC DET RPN
Identify Process Step (if needed) What is the critical Input? In what ways does the Input fail? What are the consequences How Severe is the failure effect to the project objective? What causes the Critical input to fail? How often does a cause occur? What are the existing controls and procedures (inspection and test) that prevent lfailure? How well can you detect the cause? What are the actions for reducing the occurrence of the Cause, or improving detection? Whose Responsible for the recommended action? What are the actions taken with the recalculated RPN? Be sure to include completion month/year
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Failure Modes and Effects Analysis (FMEA) Note: Failure = loss of performance

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