Creating a thorough post-mortem report is essential for learning from incidents and improving processes. Here's a breakdown of the key components of a post-mortem report:
- Brief Summary:
- Start with a concise paragraph summarizing the incident.
- Include details like what happened, duration, impact, and how it was resolved.
- Clearly state the time zone for all timestamps.
- Detailed Timeline:
- Provide a chronological account of key events during the incident.
- Include the start time, notifications, actions taken, and resolution.
- Specify dates, times, and time zones for each event.
- Root Cause Analysis:
- Explain in detail what led to the issue, such as configuration changes or human errors.
- The focus is on understanding the cause rather than blaming individuals.
- Identify lessons to be learned, like improving testing or automation.
- Resolution and Recovery Efforts:
- Describe the steps taken to resolve the incident.
- Include dates, times, and time zones for each action.
- Provide rationale and reasoning behind each decision.
- Highlight the outcomes of each step.
- Preventive Actions:
- List specific actions to prevent a recurrence of the incident.
- Consider improvements in monitoring, automation, or response procedures.
- Identify gaps or deficiencies that need attention from relevant parties.
- Acknowledging What Went Well:
- Highlight aspects that worked effectively during the incident.
- Recognize fail-safe or fail-over systems that minimized downtime.
- Emphasize the value of preventive systems and their benefits.
- Closing Remarks:
- Conclude the report by emphasizing the importance of learning from mistakes.
- Encourage a culture of owning, learning, and improving from errors.
In summary, a well-structured post-mortem report not only identifies the causes of an incident but also emphasizes learning, improvement, and the recognition of successful preventive measures. It helps organizations grow and become more resilient in the face of future challenges.