Corrective Action Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• This report is designed to record detailed information of a corrective action task or tasks that has not been completed by a specified due date. This report is an official documented record and can and will be used if required for future disciplinary action

Employee details

• Employee Name

• Employee I.D

Task details

• What was the specific task that was required to be completed?

• When was the task due to be completed by?

  Date

• What method was used to notify the employee that they had a specific task requiring corrective action?

• Did the employee acknowledge that they received and understood the details of the task that was required?

  Yes

  No

  N/A

• Did the employee acknowledge that they understood when this task was due by?

  Yes

  No

  N/A

• Are you satisfied with the reason why this task was not completed?

  Yes

  No

  N/A

• Have you explained that non compliance to a fair and reasonable directive may result in disciplinary action?

  Yes

  No

  N/A

• Is disciplinary action required in this instance. If not provide a brief description as to why

  Yes

  No

  N/A

• When will the corrective action task be reviewed to confirm complete?

  Date

• Does the employee understand that if this task is not completed by the review date disciplinary action will be taken?

  Yes

  No

  N/A

Conclusion

• I hereby acknowledge that this report has been carried out in a fair and reasonable manner. I acknowledge that this report may be used for disciplinary action and I acknowledge that all information is accurate to the best of my knowledge.

  Sign