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PT. XYZDate / Revion :
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Register No :
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Failure Modes and Effect Analysis (FMEA) Form
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Depatment :____________________________
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Process / Product Name:____________________________
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Responsible area:____________________________
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Process Step / InputStandardPotential Failure MadesPotential Failure EffectsS E V E R I T YPotential CausesO C C U R R E N C ECurrent ControlsD E T E C T I O NRPNActions RecommendedResp.Actions TakenS E V E R I T YO C C U R R E N C ED E T E C T I O NR P N
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What is the process step and input under investigation ?In what ways does the key input go wrongWhat is the impact on the key Output Variables ( custumers Requirement )?What causes the key input go wrong ?What are the existing controls and procedures ( inspection and test ) that prevent eitheir the cause or the failure mode?What are the actions for reducing the occurrence of the cause, or improving detection?What are the completed actions taken with the recalculated RPN
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Form code : FMEA, Rev : 00, date : 01-10-10
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