Figure 10. An Example Failure Analysis Report Form
  FAILURE ANALYSIS REPORT 1. NO. 2. PAGE 1
     OF ________
3. PROJECT NAME OR NUMBER



4. SYSTEM 5. SERIAL NO. 6. ENVIRONMENT / TEST LEVEL 7. MALFUNCTION DATE 8. OPERATING HOURS 9. REPORTED BY
MAJOR COMPONENT OR UNIT



10. NAME 11. REF. DES. 12. PART NO. 13. MANUFACTURER 14. SERIAL NO.
SUB ASSEMBLY



15. NAME 16. REF. DES. 17. PART NO. 18. MANUFACTURER 19. SERIAL NO.
SUB ASSEMBLY



20. NAME 21. REF. DES. 22. PART NO. 23. MANUFACTURER 24. SERIAL NO.
PART



25. NAME 26. REF. DES. 27. PART NO. 28. GENERIC NO. 29. MANUFACTURER 30. SERIAL NO / DATE CODE
31. RELATED DOCUMENTATION



32. HISTORY



33. ANALYSIS



34. CONCLUSIONS



35. CORRECTIVE ACTION / RECOMMENDATIONS



36. CORRECTIVE ACTION BY



37. DOCUMENT NO. 38. EFFECTIVITY
39. PREPARED BY



DATE 40. APPROVAL (RELIABILITY) DATE 41. PROBLEM NO.
42. APPROVAL (ENGINEERING)



DATE 43. APPROVAL (PROGRAM) DATE 44. DISTRIBUTION