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003 Corrective Action Report Form

This document is a corrective action request form regarding a problem identified at an Indonesian technology company. It provides sections to document the problem identification including part number, affected quantity, defect description, containment actions taken, root cause analysis, permanent corrective actions, prevention of recurrence, and monitoring/validation procedures. The form is used to track an issue through containment, problem solving, implementation of permanent fixes, and validation to prevent future occurrence.

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455 views

003 Corrective Action Report Form

This document is a corrective action request form regarding a problem identified at an Indonesian technology company. It provides sections to document the problem identification including part number, affected quantity, defect description, containment actions taken, root cause analysis, permanent corrective actions, prevention of recurrence, and monitoring/validation procedures. The form is used to track an issue through containment, problem solving, implementation of permanent fixes, and validation to prevent future occurrence.

Uploaded by

Ridwan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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INJ / QC / C

PT VS TECHNOLOGY INDONESIA

CORRECTIVE ACTION REQUEST


REPORT NO. : Date Issued: To Be Replied :
Please tick accordingly IPQC - In Process QC Finishing - QC Supplier Noncofirmity (I

OQC - Out Going QC Customer complaint Others :

( D1 ) PROBLEM IDENTIFICATION
Date of Complaint Assigned By Responsible Department or Supplier
Part No. & Part Name Department / supplier :
Qty Affected : Sample Size: Team Leader :
Lot Size : Rej. % : Team Member :
( D2 ) DEFECT DESCRIPTION (include Diagram / Spec if any) : Issued by

( D3 ) CONTAINMENT ACTION (e.g. Inspection, sorting, reworking, subtituting, resource)


PIC

Validation Result Qty Inspcted : Failed Qty :


( D4 ) ROOT CAUSE ANALYSIS & VERIFICATION : PIC

( D5 ) & ( D6 ) PERMANENT CORRECTIVE ACTION & VERIFICATION :


PIC Target Date
(e.g. Poka - Yoke)

Reported by: Approved By :


( D7 ) PREVENT RECURRENCE :
PIC Target Date
(e.g. Policies, practise & procedures modification)

Reported by : Approved By :
( D8 ) MONITORING / VALIDATION :
3 Subsequence Lots Monitoring
Lot Production Date / Shif OQC Tag No. / Work Order / GRN Inspection Result

1 OK / NG
2 OK / NG
3 OK / NG
Others (Please specify)
Prepared By :

RESULT : OK / NG

Retention Period : 2 Years


/ QC / CAR / 003

firmity (IQC)

Approved by

Date completed

Date completed

Actual Date

Actual Date

ult
Closed By :

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