Title Page

  • Conducted on

  • Prepared by

  • Protocol Title

  • Location

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

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.