Lumiform
Features Solutions Resources Templates Enterprise Pricing
Select a language
Englishen
Deutschde
Françaisfr
Españoles
Português (BR)pt-BR
en
Contact salesLog in
Sign up
Back
Englishen
Deutschde
Françaisfr
Españoles
Português (BR)pt-BR
Features Solutions Resources Templates Enterprise Pricing
Free demo
Log in
en
Book a personal demoView video demoContact sales
Explore
Resource hubCentral repository for all Lumiform resourcesCustomer storiesReal-world successes and experiences with Lumiform.
Learn
Template collectionsComprehensive collections of best practice templates.Topic guidesComprehensive safety, quality, and excellence insights.LexiconDefinitions key to quality, safety, and compliance.
Support
Developer's guideTechnical documentation for developers.Help centerAssistance with onboarding and platform mastery.
Featured reads
Explore our collection of 38 free preventive maintenance checklists

Template collection

Explore our collection of 38 free preventive maintenance checklists

Start reading
Your guide to performing and documenting efficient child care observation

Topic guide

Your guide to performing and documenting efficient child care observation

Start reading
Lumiform as customer journey mapping tool in gastronomy

Success story

Lumiform as customer journey mapping tool in gastronomy

Start reading
Book a personal demoView video demoContact sales
By industry
Food and hospitalityManufacturingConstructionRetailTransport and logisticsFacility managementView all industries
By business needs
Health and safetyQualityOperational excellenceRisk management and complianceView all business needs
By use case
Safety management softwareEnergy audit appForklift inspection appBuilding management softwareVehicle inspection appQMS appKaizen method appProperty inspection appRestaurant inspection appElevator management appProject management softwareFire inspection app
View all app uses
Book a personal demoView video demoContact sales
Overview
Template libraryDiscover over 12,000 free, ready-made and expert proofed templates.
Use cases
CleaningMaintenanceRisk assessmentSupply chainIncident management
Business needs
Health and safety managementQuality managementOperational excellenceRisk management and compliance
Industries
Food and hospitalityManufacturingRetailTransport and logisticsConstructionFacility management
Book a personal demoView video demoContact sales
Overview
Product overviewAll features
Capabilities
Digitize
Form builderMobile AppActions
Automate
Workflow automationApprovalsIntegrations
Transparency and accountability
ReportsAnalytics
Orchestrate
Administration
Book a personal demoView video demoContact sales
Templates
Safety root cause analysis template

Safety root cause analysis template

Enhance workplace safety with our safety root cause analysis template. This tool helps organizations systematically identify and address safety hazards, promoting a safer and more compliant working environment.

Use this template
or download pdf
Safety root cause analysis template

Enhance workplace safety with our safety root cause analysis template. This tool helps organizations systematically identify and address safety hazards, promoting a safer and more compliant working environment.

Use this template
or download pdf

About the Safety root cause analysis template

Using a safety root cause analysis template is crucial for enhancing workplace safety and preventing future incidents. This template provides a structured approach to identifying and analyzing the root causes of safety-related issues. 

By systematically exploring all contributing factors, you can develop effective strategies to mitigate risks. The primary purpose of this template is to help you uncover the underlying reasons for safety incidents, enabling you to implement corrective actions that prevent recurrence. 

It organizes information clearly, allowing you to focus on critical areas that need improvement. This ensures a comprehensive analysis that leaves no stone unturned. Using this root cause analysis template fosters collaboration among team members, encouraging open discussions and diverse perspectives.

 Additionally, it streamlines the process of identifying and addressing safety concerns, leading to more accurate and efficient problem-solving. By adopting this template, you enhance your ability to maintain a safe and secure working environment, ultimately protecting your team and assets.

Key elements of a safety root cause analysis template

This analysis template is designed to effectively identify and address the underlying causes of safety incidents. Here are the key elements that make this template effective:

  • Incident description: This section captures the specifics of the safety incident, including what happened, when, and where. Providing a clear incident description ensures everyone understands the context and scope, setting a solid foundation for analysis.
  • Contributing factors: This section identifies potential factors that may have contributed to the incident, such as environmental conditions, equipment failures, or human errors. By categorizing these factors, you can systematically explore different areas that might have influenced the incident.
  • Root cause identification: Here, you delve deeper into each contributing factor to determine the root causes. This thorough examination helps ensure that no potential cause is absent, allowing for a more accurate and comprehensive analysis.
  • Corrective actions and follow-up: This section outlines steps to address the identified root causes, assigns responsibilities, and sets timelines for implementation. It ensures accountability and facilitates effective resolution, ultimately enhancing your workflow and reducing future incidents.

When to use a safety root cause analysis template

A safety root cause analysis template is most beneficial when you need to thoroughly investigate and address the causes of safety incidents. Use this template in scenarios where an incident has occurred that impacts employee safety, operational efficiency, or regulatory compliance.

It is particularly useful in industries like manufacturing, construction, and healthcare, where understanding the root causes can prevent future incidents. You should also apply this template when you need to improve safety protocols or implement corrective actions. 

By systematically identifying contributing factors, you can develop effective solutions that enhance workplace safety. Additionally, use it during safety audits or compliance checks to ensure all potential issues are addressed comprehensively.

In any scenario where detailed analysis and accountability are neccesary, this root cause analysis template serves as a valuable tool to guide your team through a structured problem-solving process, ensuring effective resolution and continuous improvement.

Related categories

  • Operational excellence templates
  • General templates
  • Templates for business processes
Preview of the template
Incident Details
Incident date
Time of incident
Location of incident
Incident description
Risk Assessment
Hazard identified
Potential consequences
Risk level
Corrective Measures
Immediate actions taken
Root cause analysis
Recommended corrective actions
Person responsible
Target completion date

More templates like this

5 whys root cause analysis template
5 whys root cause analysis template
The 5 whys template is a powerful tool that guides you through a straightforward yet effective method of asking "why" multiple times to uncover the root cause of a problem.
Quality assurance templates
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.
Templates for business processes
Human Error Root Cause Analysis
Human Error Root Cause Analysis
This template focuses on human error, helping you analyze and mitigate mistakes in the workplace.
Templates for business processes
Medical root cause analysis template
Medical root cause analysis template
Tailored for healthcare settings, this template assists in analyzing medical errors and their causes.
Templates for business processes
Analyze the causes of an accident with a root cause analysis template
Analyze the causes of an accident with a root cause analysis template
Use this root cause analysis template to determine the root cause of a problem.
Templates for business processes
Joint commission root cause analysis form
Joint commission root cause analysis form
This form aligns with Joint Commission standards, helping you conduct thorough root cause analyses in healthcare.
Templates for business processes

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.

5 whys method: A practical guide for root cause analysisRoot cause analysis: A comprehensive guideErgonomics safety: Your essential guide to a thriving workplaceFire risk assessment: A practical blueprint to fire safetyWorkplace hazards: Effective management techniques
See all topic guides

Template collections

See comprehensive collections of best practice templates related to this topic.

14 free root cause analysis templates for effectivenessFree 5 whys templates for root cause analysis5 free corrective action forms for quality control and safetyTop 10 free Six Sigma templates in Lumiform13 free quality audit checklists
See all template collections

Use cases

Check out how the Lumiform software can be utilized for related use cases.

Apply Lumiform's workflow automation platform to all use casesKaizen softwareRisk management software for anticipating and adressing safety risksIntuitive internal control software for your businesssInspection software
See all use cases

Other resources

Explore all the additional resources we offer to assist you in mastering this topic.

3 poka yoke methods6 main types of maintenanceWhat is 5S?To whom is continuous improvement important4 benefits of safety management and how to communicate themHow digitization improves construction safety

Frequently asked questions

What is a safety root cause analysis template?

A safety root cause analysis template is a structured tool that helps to identify and analyze the underlying causes of safety incidents. It helps teams systematically explore contributing factors, ensuring comprehensive solutions that prevent future incidents and enhance workplace safety.

How does a safety root cause analysis improve safety management?

The analysis enhances safety management by providing a clear framework for identifying root causes. It encourages thorough investigation and collaboration, leading to effective corrective actions and reducing the likelihood of future safety incidents.

Who should use a safety root cause analysis template?

Safety officers, managers, and quality assurance professionals in industries such as manufacturing, construction, and healthcare should use this template. It benefits anyone responsible for improving safety protocols and reducing incidents by offering a systematic approach to problem-solving.

What are common challenges in safety analysis and how can they be overcome?

Common challenges include incomplete data collection and biased analysis. These can be overcome by ensuring thorough data gathering and encouraging diverse team input. Using the template to guide discussions and verify findings with evidence promotes a balanced and accurate approach to problem-solving.


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.
Lumiform logo
Platform
HomeSign upProductAll featuresPricingEnterpriseTrust and securityCustomer success offeringsDownload the app
Solutions
IndustriesFood and hospitalityManufacturingConstructionRetailTransport and logisticsFacility management
Business needsHealth and safetyQualityOperational excellenceRisk management and compliance
Uses cases
Learn
Template collectionsTopic guidesLexiconHelp centerJournalInfographicsVideos
Resources
Lumiform templatesby industryby use caseby business needAll categories
Customer storiesDeveloper APIResource hubIntegrations
Company
AboutJobsLegalBook a demoContact sales
© 2025 LumiformTerms and conditionsPrivacyData processingSitemap
App StoreGoogle play