TapRooT® Quality Causal Factor Worksheet
Review the sequence of events on your SnapCharT® and answer these questions:
1. ADVERSE CONDITION: What was the condition adverse to quality that you were trying to
prevent?
2. INCIDENT: What was the worst consequence of the condition adverse to quality?
3. STARTING ERRORS: What mistakes, errors, or equipment failures started a sequence of events
that led to the Incident?
4. FAILED CATCH: What mistakes, errors, or equipment failures failed to catch or stop the
sequence of events that led to the Incident?
5. MISSING QUALITY SYSTEMS: What mistakes, errors, or equipment failures caused a quality
system to be missing or fail?
6. EQUIPMENT FAILURE CATCH: What mistakes or errors failed to notice or prevent an
impending equipment failure?
7. MADE OUTCOME WORSE: What mistakes, errors, or equipment failures made the outcome of
the Incident worse?
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