Radiotherapy FMEA Scoring Form
Score a radiotherapy process, identify failure modes, and capture risk ratings and recommended actions.
Incident / Process Identifier
Process Step / Incident Title
*
Department / Site
*
Machine / Area
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
FMEA Scoring Inputs
Severity score (1–10)
*
Occurrence score (1–10)
*
Detectability score (1–10)
*
Risk priority number (RPN)
Risk Review and Actions
Current risk status / priority
*
Low
Moderate
High
Critical
Identified failure mode / effect summary
*
Recommended corrective or preventive actions
*
Submit
Should be Empty: