Root Cause Analysis Investigation Form
This form can be used to facilitate and document the steps of a root cause analysis.
Guidance Document for Root Cause Analysis Investigation Form
This document is a supplementary tool to be used with the Patient Safety Authority Root Cause Analysis (RCA) investigation form. It will guide you step-by-step on how to complete the RCA form.
Event Analysis Timeline Attachment (blank) & (PDF)
This template can be used to construct a timeline of an event.
Event Analysis Cause and Effect Diagram Attachment
This template can be used to construct a fishbone-style cause and effect diagram.
Event Analysis Interview Documentation
This form can be used to track questions and responses from interviews conducted during an investigation.
Action Agenda
This form can be used to track the implementation of improvement strategies.
Specific Event Type Prompts:
CAUTI Event Investigation Prompts
This is a list of questions and factors to consider when investigating a catheter-associated urinary tract infection (CAUTI).
CLABSI Event Investigation Prompts
This is a list of questions and factors to consider when investigating a central line-associated bloodstream infection (CLABSI).
Lab Event Investigation Prompts
This is a list of questions and factors to consider when investigating a lab event.
Medication Event Investigation Prompts
This is a list of questions and factors to consider when investigating a medication event.
Suicide Event Investigation Prompts
This is a list of questions and factors to consider when investigating a death by suicide.
Wrong-Site Surgery Investigation Prompts
This is a list of questions to consider when investigating a wrong-site surgery.
