Prepared By:                                                                                                                                     Date:
                                                                         Name of System/Subsystem analysed                                                                     Failure Mode and Effects  Analysis                                                                          Reviewed By:                                                                                                                                     Date:
                                                                                                                                                                                                                                                                                           Approved By:                                                                                                                                     Date:
                                                                                 Failure Mode Identification                                           Failure Mode Effects                   Root Causes                                  Failure Management                                                 Reliability Prediction                               Failure Classification                                        RPN Management
                                                                                                                                                                                              Identification
                                                                                                                                                                                                                  )     Diagnostic/ Detection                                                                                                                                                                                                                            )
                                                                                                                                                                                                                  C                                                                                                                                                                                                                                                      C    )
                                                                                                                                                                                                                  C                                                                                                                                                                                                                                                 )    C    T
                                                                                                                                                                                                             )                                                                                                           Effective                      (Ss) Severity   (Sr) Severity  (SPF) Single                                                                 V    O    E
                                                                                                                                                                          Overall                                 O                                                                          Item                                                                                                                                                                   E    (    D
                                                                                                                                                         Next Higher                       Potential Root    C    *                                                                )                        Modal          Modal                          impact on      impact on       Point of         Action(s)                                                           (
                                                                                                                                                                                                             C    V                                                                                                                                                                                                                                                 S    e     
                                                     Ref# (ID)          Component (LRU/LLRU)                  Potential Failure Mode     Local Effect                     System        )                                                            Mitigation    Comments        T        Failure                                    Data Source                                                                        Action(s)  Taken     Responsibility       (    c    n
                                                                                                                                                         Level Effect                   V     Causes         O    E                                                                E                   Apportionment      Failure                          Safety        Reliability     Failure       Recommended                                                       n          N
                                                                                                                                                                                                             (                                                                                                                                                                                                                                                      y         o     P
                                                                                                                                                                        Escalation      E                         S                                                                D         Rate                                                                                                                                                                   t    e    i
                                                                                                                                                                                                                  (                                                                (     N                                  Rate                          (Yes/No)        (Yes/No)       (Yes/No)                                                                   i    r    t     R
                                                                                                                                                                                        S                    e                                                                                                                                                                                                                                                      r    u    c      
                                                                                                                                                                                        (                    c    y                                                                n     P                                                                                                                                                                          e         e     g
                                                                                                                                                                                                                  t                                                                                                                                                                                                                                                 v    c    t
                                                                                                                                                                                        y                    n    i                                                                o     R                                                                                                                                                                                          n
                                                                                                                                                                                        t                    e    l     Local          Central                                     i                                                                                                                                                                                e    c    e     i
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                                                                                                                                                                                        r                                                                                          c     a                                                                                                                                                                          S    O    D     l
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                                                                                                                                                                                        e                         i                                                                e     u
                                                                                                                                                                                        v                    c    t                                                                t     t                                                                                                                                                                          w    w    w     s
                                                                                                                                                                                                             c    i
                                                                                                                                                                                        e                         r                                                                e     c                                                                                                                                                                          e    e    e     e
                                                                                                                                                                                        S                    O    C                                                                D     A                                                                                                                                                                          N    N    N     R
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                                                                                                                                                                                                                0                                                                      0                                                                                                                                                                                           0