2014根本原因分析报告表.docVIP

ROOT CAUSE ANALYSIS REPORT FORM 1 根本原因分析报告表一 AGENCY: 机构： Reference No.: 参考号码：Program/Facility: 计划/设施： Region 区 STS STS的 North 北 South 南 West 西Consumer ID: 消费者识别码： Age: 年龄： Gender: M F 性别：男女 MR Level: 议员级别： NR 上午十时十五分 ML 毫升 MO 莫 SV 希沃特 PR 公关 City/Town: 市/镇： Date of Event: 活动日期： Date RCA Completed: RCA的完成日期： 1. 1。 THE EVENT – Describe what happened and any harm that resulted. 事件 - 描述发生了什么，而导致的任何损害。 Identify the proximate cause, if known. 确定近因，如果知道的话。 RCA Team Members: RCA的团队成员：Team Leader: 组长： 2. 2。 BACKGROUND FACTORS SUMMARY– Answer the following questions (brief summary only- attach supporting documents). 背景与因素的摘要， 回答下列问题（摘要只，附上证明文件）。 2.1 2.1 What was the sequence of events that was expected to take place? 什么是地方序列采取预期的事件呢？ Attach flowchart if available. 如果有附加流程图。 Description: 说明：  2.2 2.2 Was there a deviation from the expected sequence? 是否有一个序列偏离预期？ ? Yes ? 是No ? 无 If YES, describe the deviation. 如果是，请描述的偏差。 Attach flowchart if available. 如果有附加流程图。 2.3 2.3 Was any deviation from the expected sequence likely to have led to or contributed to the adverse event? 在任何序列偏离预期可能导致或促成了不良事件？ ? Yes ? 是No ? 无NK ?NK细胞 If YES, describe with causal statement. 如果是，请描述与因果发言。  2.4 2.4 Was the expected sequence described in policy, procedure, written guidelines, or included in staff training? 预期序列是在描述的过程政策，书面指引，或包括在员工培训？ ? Yes ? 是No ? 无NK ?NK细胞 If YES, cite source. 如果是，引用的来源。 2.5 2.5 Does the expected sequence or process meet regulatory requirements and/or practice standards? 是否预期的序列或过程符合要求和监管/或执业标准？ Cite references and/or literature reviewed by the team. 引用参考文献和/或文献回顾了队伍。 ? Yes ? 是No ? 无NK ?NK细胞 If NO, describe deviation from requirements/standards. 如果没有，说明偏离标准要求/。2.6 2.6 Did human action or inaction appear to contribute to the adverse event? 难道人的行为或不出现不良事件做出贡献？ ? Yes ? 是No ? 无NK ?NK细胞 If YES, describe the actions and how they contributed. 如果是，请描述他们的行动和如何作出了贡献。  2.7 2.7 Did a defect, malfunction, misuse of, or absence of equipm