Event Investigation Guidelines

• Step Six:  Validate Root Cause(s)

The purpose of this step is to ensure that the identified root cause(s) is/are actually the root cause. This is achieved by passing each identified root cause through a check of three criteria. For explanation, we will return to our example of Fred slipping on the ice, where we have identified "ice accumulation in the walkway" as our root cause. Now let's test it:

Criteria #1:     The event/problem would not have occurred had the root cause not been present.

Based upon our knowledge of the event, we can say with fair certainty that if ice had not been present in the walkway, Fred would not have slipped.

Criteria #2:     Correction or elimination of the cause(s) will ensure that the problem will not recur due to the same causal factors.

If the ice is removed from the walkway and/or not allowed to accumulate, slippage due to ice in this walkway will not occur.

Criteria #3:     Correction or elimination of the cause(s) will preclude repetition of the specific problem or of similar problems.

Measures to remove / prevent accumulation of ice in this walkway will also prevent slippage due to ice in other walkways when employed in those locations.

All three criteria satisfied, we know with a high level of certainty that "ice accumulation in the walkway" is indeed the root cause of Fred slipping. We now have a validated root cause.