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Incident root cause analysis template

Incident root cause analysis template

This template focuses on incidents, helping you document and analyze events to prevent future occurrences.

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The Lumiform application helps frontline teams uphold internal standards effortlessly.
  • Customize this template or build your own
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  • Assign and track corrective actions
  • Get reports and analyse your data
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Incident root cause analysis template

This template focuses on incidents, helping you document and analyze events to prevent future occurrences.

Use this template with Lumiform

The Lumiform application helps frontline teams uphold internal standards effortlessly.
  • Customize this template or build your own
  • Fill out templates via mobile app
  • Assign and track corrective actions
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

This incident root cause analysis template allows you to find opportunities for improvement based on workplace incidents. It walks you through a structured investigation process that moves beyond surface-level symptoms to uncover the true causes.

The Pareto Principle demonstrates that approximately 80% of problems come from just 20% of causes, so systematic root cause analysis essential for effective problem-solving. This template is particularly valuable when you’re investigating recurring safety incidents. For example, a healthcare facility might discover that medication errors are caused by communication gaps during shift changes.

Related categories

  • Operational excellence templates
  • Risk management and compliance templates
  • General templates
  • Incident management templates
Preview of the template
Incident Details
Incident Date
Incident Location
Incident Description
Root Cause Analysis
What happened?
When did it happen?
Where did it happen?
Who was involved?
Why did it happen?
How can it be prevented?
Corrective Actions
Corrective Action
Responsible Person
Completion Date

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Related resources

Access a complete set of resources aimed at maximizing safety, quality, and operational excellence, including detailed guides, related templates, and real-world use cases.

Topic guides

Read in-depth guides covering key topics related to this article.

Root cause analysis: A comprehensive guide5 whys method: A practical guide for root cause analysisA3 lean explained: A guide to efficient problem-solving 
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14 free root cause analysis templates for effectiveness13 free quality audit checklists8 free Kaizen templates for continuous improvement
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Apply Lumiform's workflow automation platform to all use casesKaizen softwareRisk management software for anticipating and adressing safety risks5 whys software
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5 why analysis templateHow to implement operational excellenceHow to measure operational excellence4 ways process improvement increases profits

Frequently asked questions

How do I determine the actual root cause versus just symptoms of the problem?

When using this template, apply the “5 Whys” technique in the “Why did it happen?” section. Ask “why” repeatedly for each answer until you reach a cause that doesn’t prompt another “why.” Look for systemic issues rather than blaming individuals. The most effective root causes identify specific process breakdowns or system failures that can be corrected through tangible actions.

How can I ensure my corrective actions actually prevent similar incidents

Ensure each corrective action is specific, measurable, and directly linked to an identified cause. Assign clear responsibility and completion dates as indicated in the template. After implementation, verify effectiveness by monitoring relevant metrics and conducting follow-up reviews to confirm the incident hasn’t recurred under similar circumstances.

Who should be involved in completing this root cause analysis template?

Include a diverse team with different perspectives: someone familiar with the process where the incident occurred, a subject matter expert, the supervisor responsible for the area, a safety representative, and workers directly involved (if appropriate). This diversity helps overcome individual biases and ensures you capture technical, operational, and human factors that contributed to the incident.


This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.
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