Action Closeout

• Action #

• Date

  Date

• Location

• Author

• Signature

  Sign

INFORMATION

• Action #

• Name, Source, Department

• Date non-conformity identified

  Date

• Date action closed

  Date

• Description of Non-conformity

• Action taken

• Evidence

  Media

• Evidence

  Drawing

• Evidence

• EVIDENCE MUST PROOVE THAT CLOSE-OUT HAS BEEN ACHIEVED