Investigate recurring couch breaks to root cause

What is going on

The paper machine has recorded six wet end breaks at the couch in three days across both panels, machine efficiency has dropped below the 88 per cent plan target and off-grade tonnes are rising. Shift log notes mention forming fabric edge wear at the drive side, a refiner freeness drift in stock preparation, and a recent grade change to 140 gsm fluting. The forming fabric change is scheduled for 17 October. The General Manager has rejected another setpoint adjustment and wants a proper investigation using the Root Cause Problem Solving Report Template, with a verified cause, corrective actions with owners and dates, and a measure that shows when the problem is fixed.

Your brief

Lead a structured root cause investigation of the couch breaks using the site template and data from the Production Shift Log and the Maintenance Work Orders, involve the crews, verify the cause against the data, define containment and corrective actions, and present a report ready for the daily production meeting.

Work through it

You do not need to do it all. Doing a few of these will show you what the work is like. Your ticks and notes stay on this device.

• Read the Root Cause Problem Solving Report Template and the Quality Policy improvement section, and set out the investigation steps and who you will involve from each panel.
• Extract the break data from the Production Shift Log records and build a problem statement with the frequency, timing, grade, location and the efficiency and off-grade cost.
• Define containment actions that protect the customer and the machine while the cause is found, with an end date, and raise or update any Maintenance Work Orders needed.
• Build a cause and effect analysis across machine, method, material and measurement, including the forming fabric wear, the freeness drift, the grade change and the couch vacuum, and record the causes you rule out with the data that rules them out.
• Identify the root cause you can verify with the data and describe the verification you carried out or would carry out on the machine.
• Set corrective actions with owners and due dates, including any change to the setpoint sheet or procedure, any training and any shutdown scope change, and update the affected work orders.
• Define the verification measure and period, complete the report using the template fields, and write a two-minute summary for the daily production meeting.
• Assess whether the investigation reveals any safety or environmental risk, and record it in the Incident and Hazard Register if it does.

What someone in this role would produce

• Problem statement with data
• Containment plan
• Cause and effect analysis with ruled-out causes
• Completed Root Cause Problem Solving Report
• Production meeting summary and updated work orders