Corrective Action Form PDF
Corrective Action Form PDF
Corrective Action Form PDF
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Corrective Action Report
Cust. Complaint #
(If Space Is Limited Use An Additional Sheet Of Paper And Staple It To This Corrective Action)
1 Type: Customer Supplier Internal Customer/Supplier:
Part/Mat'l #: External Contact Name
Quantity: External Contact Phone:
Initiated By: Forward To: (for step 2)
Initiation Date: Due Date: Pending Due Date:
Respond To Customer? Yes No By Date: Plant Visit Required? Yes No
Describe The Problem: Can the problem affect other products or processes?
List actual actions taken, not actions that will be taken in the future! If additional time is required see Q.A. to place C/A in pending status.
6 List Data That Verifies Corrective Action: Was FMEA Revise? Yes No
(required only when C/A is for product or process)
Evidence Required
7 Department Manager: Accept Reject Signature: Date:
8 Congratulate Team! Note: Quality Assurance Manager returns C/A to Q.A. Analyst for re-issue or close C/A.
qs-141A 1/19/99