DOE G 414.1-5
correcting the immediate or apparent cause without addressing the root cause. If similar
problems subsequently occur, trending may assist in identifying the commonalities of the
problems in determining their causes.
Develop conclusions based on the facts identified and analysis of the causal factors to
determine the details of what the specific problem is, and how and why it became a problem.
The conclusions may also address specific concerns to the site/organization in relation to the
Determine if the same or similar problem findings have previously occurred or been
identified. If so, review the assessment or event that identified the problem finding,
results of the finding evaluation, and the effectiveness of the corrective actions
implemented to resolve and prevent recurrence of that finding. This may include a
review of local and DOE-wide corrective action programs (i.e., CAMP) and incident
reporting processes (i.e., ORPS and CAIRS). This information should be included in
the current evaluation of the problem finding.
Upon completion of the evaluation and determination of conclusions for significant problem
findings based on a graded approach, a quality review and critique of the finding evaluation
process should be conducted to validate the facts and causal factors, which include root
causes in support of the conclusions. Any identified inconsistencies should be reexamined
and resolved before development of corrective actions.
Trending Identified Problem Findings
Identified problem findings and their associated causes should also be analyzed to determine the
existence of trends to identify the same or similar occurrences, generic problems, vulnerabilities,
and cross functional weaknesses at the lowest level before significant problems result. Trending
typically identifies problem categories, responsible organizations, and specific activities or
conditions. Benefits of trending include:
The ability to document historical data consistently in measurable, visible terms;
Identify changes in performance as they occur; and
Develop leading indicators that identify degrading trends.
A consistent trend coding system would assist in analyzing the problem findings. This trending
data should be constantly analyzed, updated and summarized; and the results should be reported
To assist in analyzing and trending identified problem findings and developing corrective
actions, the assessing organization and/or site/organization manager should determine the
applicable Guiding Principles and Core Safety Management Functions for Integrated Safety
Management outlined in DOE P 450.4, Safety Management System Policy for each finding. This
will assist managers in identifying broader causal factors that can reduce the potential for similar