Reference #: 000-0001 Process owner: D. Soltren Leader/facilitator: D.

Soltren Note taker: N/A Revision #: 0 Date: 8/29/2022

A3 Form
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l Title Scope (Location, area, line, department, boundaries, etc.)
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D Name Role Name Role
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i Process Name Process Map Exist? Start Date Estimated Completion Date
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Problem Description (Initial condition) Problem Category
Quality Waste and efficiency
Cost Health and safety
Delivery Customer satisfaction
Moral Other

Goal (Target condition) Expected Benefits (Hard savings and soft savings)

Key Metrics (Include baseline and improvement goals)

Additional documents can be attached to this form including before photos, drawings and a more detailed cost benefit analysis. Attachments?

C Cause and Effect (Brainstorming - Prioritize the causes) 5 Whys (Brainstorming - Ask, why did this occur?)
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A Why 3
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s [ ] Root Cause Analysis Summary (Prioritize in order of importance - % Contribution)
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Machine Method Measure Will addressing this cause(s) solve the problem permanently?
Additional documents can be attached to this form including a more in-depth root cause analysis and the prioritization method used. Attachments?

C Proceed with solving the problem? List of Countermeasures and Quick Wins (Brainstorming - Relate to the root causes)
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u Decision and Agreements (Explain the reasoning behind the decision) Priority Ease Cost Impact Score
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Solution Description
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Implementation Plan (Implement countermeasures)

Additional documents can be attached to this form including a more detailed implementation plan. Attachments?

R Improvement implemented? Results verified? Key Metrics

Verification Comments (Assess countermeasures) Follow-up Actions (sustaining actions to be taken - actions for establishing controls)
What? Who? When? Status

Controls Required (SOP, training, audits, SPC charts, visual controls, mistake proofing, PM, etc.)

Additional documents can be attached to this form including the after photos Attachments?

Signatures: Leader: Analyst: Process Owner: Champion: