When a system Safety Function fails it is imperative to be able to identify and analyze the potential causal contributors in a timely way and support the conclusion with compelling evidence. Yet experience has shown that this can be a formidable challenge and far too often opinions and unsubstantiated claims end up being used to support the conclusion. This tutorial will separate problem solving from Root Cause Analysis (RCA) and provide necessary conditions for starting a causal analysis. A basic understanding of probability and data analysis is also included in this tutorial to enable the investigator to make informed decisions on how to navigate the process. Navigating a RCA is a step wise decision dependent process, and coverage of decision making using a hierarchal methodology is included. The tutorial provides guidance on how to create a comprehensive RCA that shows all relevant data and decision points, with supportive decision evidence, which converges onto the most likely causal contributors with closure (corrective actions). The contents of this tutorial are applicable to wide range of problem types and useful to practitioners in all walks of life and is not restricted to system failures.
