Inspection

CAPA Report Form

Principal Investigator

Deficiency identified

Add photo evidence of deficiency if applicable

Response to deficiency

Corrective Action Plan (Action taken to correct specific deficiency identified)

Preventative Action Plan: (Action taken to prevent the recurrence of this problem in the future)

Signature of responsible personnel
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.