FMEA Form v3.

FMEA Form

Process/Product Name: Keripik pisang Prepared By:

Responsible: FMEA Date (Orig.): (Rev.):

OCCURRENCE (1 - 10)

OCCURRENCE (1 - 10)
Process Step/Input Potential Failure Mode Potential Failure Effects Potential Causes Current Controls Action Recommended Resp. Actions Taken

DETECTION (1 - 10)

DETECTION (1 - 10)
SEVERITY (1 - 10)

SEVERITY (1 - 10)
RPN

What is the process step or
feature under investigation?
In what ways could the step or
feature go wrong?
RPN
What are the
recommended actions for Who is responsible for What actions were
What is the impact on the customer if this What causes the step or feature to What controls exist that either prevent or detect
reducing the occurrence of making sure the actions completed (and when) with
failure is not prevented or corrected? go wrong? (how could it occur?) the failure?
the cause or improving are completed? respect to the RPN?
detection?

Pada saat Menimbang bahan dengan Tekstur cookies menjadi terlalu Menimbang bahan dengan Memperhatikan takaran bahan dan
penimbangan cookies takaran yang tidak akurat lembek atau keras 7 takaran yang tidak akurat 6 melakukan kalibrasi 5 210 0

Pada saat pencetakan Cetakan cookies yang Bentuk cookies akan sedikit berbeda Tidak memperhatikan Memperhatikan cetakan cookies jika
cookies sudah terdapat kerusakan dengan cetakan cookies yang tidak 8 cetakan cookies 6 terdapat kerusakan sebaiknya diganti 3 144 0
ada kerusakan dengan yang baru
Pada saat proses Durasi pengadukan terlalu Tekstur cookies menjadi terlalu Tidak memperhatikan Memperhatikan duras pengadukan
pengadukan adonan lama atau terlalu cepat lembek atau keras 8 durasi pengadukan adonan 5 adonan sebaiknya di timer 6 240 0
cookies
Pada saat proses Durasi pengovenan terlalu Cookies akan menjadi gosong, bisa Tidak memperhatikan Memperhatikan durasi pengovenan
pengovenan lama atau terlalu cepat juga belum matang jika terlalu cepat. durasi pengovenan cookies dan sebaiknya set timer pada
5 4 6 120 0
oven dengan waktu yang baik untuk
cookies

0 0

0 0

_x000D_Copyright 2016 GoLeanSixSigma.com. All Rights Reserved.

 FMEA Form v3.0

FMEA Form

Process/Product Name: Prepared By:

Responsible: FMEA Date (Orig.): (Rev.):

Potential
Process Potential Potential Current Action Actions
Failure Resp.

OCCURRENCE (1 - 10)

OCCURRENCE (1 - 10)
Step/Input Failure Mode Causes Controls Recommended Taken

DETECTION (1 - 10)

DETECTION (1 - 10)
Effects

SEVERITY (1 - 10)

SEVERITY (1 - 10)
What are the

RPN
What is the Who is
What causes What controls recommended What actions
What is the In what ways impact on the responsible
the step or exist that either actions for reducing were completed
process step or could the step or customer if this for making
feature to go prevent or the occurrence of (and when) with
feature under feature go failure is not sure the
wrong? (how detect the the cause or respect to the
investigation? wrong? prevented or actions are
could it occur?) failure? improving RPN?
corrected? completed?
detection?

Fill carafe Wrong Coffee to Faded level Visual Replace old Mel Carafe
with water amount of strong or 8 marks on 4 Inspection 4 128 carafes replaced 8 1 3
water weak carafe 9/15
Water spilled None Train Flo Trained on
8 from carafe 5 9 360 employees 9/20 8 2 7

Water too Coffee too Faucet not Finger Train Flo Trained on
warm strong 8
allowed to 8 4 256 employees 9/20 8 2 6
run cool
Employee None Train Flo Trained on
unaware of employees 9/20
8 7 7 392 8 1 8
need for cool
water
Unclean Foreign Carafe not Visual Appoint Alice Vera
carafe objects in 10 washed 4 Inspection 4 160 inspector appointed 10 1 4
coffee before storage 9/21
Bad tasting Carafe Training Create storage Alice Bin & visual
coffee 10 stored 7 5 350 & instructions instructions 10 2 3
improperly done 9/25

_x000D_Copyright 2016 GoLeanSixSigma.com. All Rights Reserved.

 FMEA Form v3.0

FMEA Form

RPN
24

112

96

64

40

60

_x000D_Copyright 2016 GoLeanSixSigma.com. All Rights Reserved.

 Severity Scale
Adapt as appropriate

Effect Criteria: Severity of Effect Ranking

Hazardous - May expose client to loss, harm or major disruption -

10
Without Warning failure will occur without warning

Hazardous - May expose client to loss, harm or major disruption -

9
With Warning failure will occur with warning

Major disruption of service involving client interaction, resulting in either

Very High 8
associate re-work or inconvenience to client

Minor disruption of service involving client interaction and resulting in either

High 7
associate re-work or inconvenience to clients

Major disruption of service not involving client interaction and resulting in either
Moderate 6
associate re-work or inconvenience to clients

Minor disruption of service not involving client interaction and resulting in either
Low 5
associate re-work or inconvenience to clients

Minor disruption of service involving client interaction that does not result in
Very Low 4
either associate re-work or inconvenience to clients

Minor disruption of service not involving client interaction and does not result in
Minor 3
either associate re-work or inconvenience to clients

No disruption of service noticed by the client in any capacity and does not result
Very Minor 2
in either associate re-work or inconvenience to clients

None No Effect 1
 Occurrence Scale

Per Item Failure

Probability of Failure Time Period Ranking
Rates

More than once per day >= 1 in 2 10

Very High: Failure is almost inevitable
Once every 3-4 days 1 in 3 9

Once every week 1 in 8 8

High: Generally associated with processes similar to
previous processes that have often failed
Once every month 1in 20 7

Once every 3 months 1 in 80 6

Moderate: Generally associated with processes
similar to previous processes which have
Once every 6 months 1 in 400 5
experienced occasional failures, but not in major
proportions
Once a year 1 in 800 4

Low: Isolated failures associated with similar

Once every 1 - 3 years 1 in 1,500 3
processes

Very Low: Only isolated failures associated with

Once every 3 - 6 years 1 in 3,000 2
almost identical processes

Remote: Failure is unlikely. No failures associated

Once Every 7+ Years 1 in 6000 1
with almost identical processes
 Detection Scale

Criteria: Likelihood the existence of a defect will be detected

Detection by process controls before next or subsequent process, -OR- Ranking
before exposure to a client

Almost Impossible No known controls available to detect failure mode 10

Very remote likelihood current controls will

Very Remote 9
detect failure mode

Remote likelihood current controls will

Remote 8
detect failure mode

Very low likelihood current controls will

Very Low 7
detect failure mode

Low Low likelihood current controls will detect failure mode 6

Moderate likelihood current controls will

Moderate 5
detect failure mode

Moderately high likelihood current controls will

Moderately High 4
detect failure mode

High High likelihood current controls will detect failure mode 3

Very high likelihood current controls will

Very High 2
detect failure mode

Current controls almost certain to detect the failure mode.

Almost Certain Reliable detection controls are known 1
with similar processes.
 FMEA Form v3.0

FMEA Form

Process/Product Name: Food Order Delivery Prepared By: Team Lead

Responsible: Manager FMEA Date (Orig.): May 1st (Rev.): May 6th

Potential
Process Potential Potential Current Action Actions
Failure Resp.

OCCURRENCE (1 - 10)

OCCURRENCE (1 - 10)
Step/Input Failure Mode Causes Controls Recommended Taken

DETECTION (1 - 10)

DETECTION (1 - 10)
Effects

SEVERITY (1 - 10)

SEVERITY (1 - 10)
What are the

RPN
What is the Who is
What causes What controls recommended What actions
What is the In what ways impact on the responsible
the step or exist that either actions for reducing were completed
process step or could the step or customer if this for making
feature to go prevent or the occurrence of (and when) with
feature under feature go failure is not sure the
wrong? (how detect the the cause or respect to the
investigation? wrong? prevented or actions are
could it occur?) failure? improving RPN?
corrected? completed?
detection?

Changing May not Run out of Not carrying Won't know Give vendor a Manager Directions
Vendors deliver on key menu proper until delivery 30-day trial created,
time items quantities copied and
10 8 10 800 distributed 10 6 10
on May 5th

0 Have vendor Manager Instituted on 10 4 1

call to confirm May 5th
quantities
0 Impose Manager Instituted on 10 6 10
penalties for May 6
missed items
0
0
0
0
0
0
0

_x000D_Copyright 2016 GoLeanSixSigma.com. All Rights Reserved.

 FMEA Form v3.0

FMEA Form

RPN
600

40

600

0
0
0
0
0
0
0

_x000D_Copyright 2016 GoLeanSixSigma.com. All Rights Reserved.

 FMEA Form v3.0

FMEA Form

Process/Product Name: Packaging Pick-up Orders Prepared By: Team

Responsible: Wesley FMEA Date (Orig.): 25-May (Rev.):

Potential
Process Potential Potential Current Action Actions
Failure Resp.

OCCURRENCE (1 - 10)

OCCURRENCE (1 - 10)
Step/Input Failure Mode Causes Controls Recommended Taken

DETECTION (1 - 10)

DETECTION (1 - 10)
Effects

SEVERITY (1 - 10)

SEVERITY (1 - 10)
What are the

RPN
What is the Who is What are the
What causes What controls recommended
What is the In what ways impact on the responsible completed
the step or exist that either actions for reducing
process step or could the step or customer if this for making action taken
feature to go prevent or the occurrence of
feature under feature go failure is not sure the with the
wrong? (how detect the the cause or
investigation? wrong? prevented or actions are recalculated
could it occur?) failure? improving
corrected? completed? RPN?
detection?

Chef to put Chef gets Delay of all 10 It takes too 10 White Board 4 400 Cross-Train all Scott 27-May 10 7 1
food into backed up food orders much time to showing kitchen staff to
containers with orders package food order handle pick-up
orders timing packaging
0
0
0
0
0
0
0
0
0
0
0
0
0
0

_x000D_Copyright 2014 GoLeanSixSigma.com. All Rights Reserved.

 FMEA Form v3.0

0
0
0
0
0

_x000D_Copyright 2014 GoLeanSixSigma.com. All Rights Reserved.

 FMEA Form v3.0

FMEA Form

RPN
70

0
0
0
0
0
0
0
0
0
0
0
0
0
0

_x000D_Copyright 2014 GoLeanSixSigma.com. All Rights Reserved.

 FMEA Form v3.0

0
0
0
0
0
0

_x000D_Copyright 2014 GoLeanSixSigma.com. All Rights Reserved.