was the behavior to the expected standard
was a procedural step forgotten or something was done not as originally
did deficiencies in judgement lead the person to make an incorrect decision or misdiagnose the problem
did the person unknowingly violate policy or procedure (implicitly or explicitly)
were policy or procedures unworkable (not enabled) or the job couldn't be done if they followed the procedure
did the person believe their actions would be better for the company, or were they trying to satisfy the boss
did the person think it was better for them personally to do it that way
did the person mean to do what they did, and or did not think or care about the consequences