000250 - CAPA Form

• Site conducted

  Select

• Date Initiated

  Date

• Issue Initiated By

• Location of Issue

• CAPA ID # (format: CAPA - YYYYMMDD - #)

Category

• Pest Control

• Sanitation

• Maintenance

• Quality

• Inventory Control

• Food Safety

• Other

• Define the Problem

Root Cause Analysis (5 Why's)

• 1. Why is this happening?

• 2. Why is this that?

• 3. Why is this that?

• 4. Why is this that?

• 5. Root Cause:

Problem Mitigation

• Responsible Person

• Target Completion Date

  Date

• Actual Completion Date

  Date

• Problem Mitigation

Corrective Action

• Responsible Person

• Target Completion Date

  Date

• Actual Completion Date

  Date

• Corrective Action

Signatures

• Site Manager Signature

  Sign

• Quality Representative Signature

  Sign