Plan-Do-Check-Act

Date: Team Member:

Problem Identify Root Cause of Problem
describe and quantify
Was the standard being followed? Yes □ No □ Why?

Why?

Why?
1: Plan

Why?

Goal Why?
specific, measurable, achievable, results-focused, time-bound

Root Cause

Containment Implementation Tasks for Long-Term Co

immediate action
Task
2: Do

Did your plan succeed or fail?

Test Results show back-up data
3: Check
3: C Will tested solution become new standard, or do
you need to test alternative solution? Implementation Tasks for Establish
Task
4: Act

Notes or Co
o-Check-Act (PDCA) Template
Department:
roblem
Counter-Measures
using the 5 whys
Option One

Pros / Benefits: Cons / Challeng

Option Two

Pros / Benefits: Cons / Challeng

Option Three

Root Cause Pros / Benefits: Cons / Challeng

Criteria to Determine Eff

ation Tasks for Long-Term Counter-Measure
Task Assigned To Deadline Completed?

r fail?
w back-up data
Areas for Improvement
mentation Tasks for Establishing Standard
Task Assigned To Deadline Completed?

Notes or Comments:
Measures
One

Cons / Challenges:

Two

Cons / Challenges:

Three

Cons / Challenges:

Criteria to Determine Effectiveness

cost, time spent, manpower,