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Corrective Action Form PDF

This document is a corrective action report template used to document issues, contain problems, determine root causes, implement corrective actions, and verify solutions. It contains 8 sections: 1) description of the problem, 2) team champion assignment, 3) containment actions, 4) root cause analysis, 5) corrective actions, 6) verification data, 7) management approval, and 8) conclusion. The goal is to resolve customer complaints, supplier issues, or internal problems and prevent reoccurrence through a structured process.

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chahi
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513 views

Corrective Action Form PDF

This document is a corrective action report template used to document issues, contain problems, determine root causes, implement corrective actions, and verify solutions. It contains 8 sections: 1) description of the problem, 2) team champion assignment, 3) containment actions, 4) root cause analysis, 5) corrective actions, 6) verification data, 7) management approval, and 8) conclusion. The goal is to resolve customer complaints, supplier issues, or internal problems and prevent reoccurrence through a structured process.

Uploaded by

chahi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MPM C.A.R.

#
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?

Is it a systemic problem that can re-occur?

Responses are required by Team Champion!


See Steering Committee for actiom
2 Team Champion: Position/Group &
(Team Roster & Tracking Sheet Required) Phone:
3 What Did You Do To Contain The Problem? If the problem affects other product/process or is systemic, how were
they contained?

(Purge System As Warranted)


4 Root Cause (s):

Ask Why 5 Times. Personnel Failure Not Acceptable!


5 What Actions Corrected The Root Cause?

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:

Quality Assurance Supervisor/Analyst: Accept  Reject  Signature: Date:

Quality AssuranceManager: 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

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