CORRECTIVE & PREVENTATIVE ACTION FORM

• Incident/Document#

• Incident Date

  Date

• Product Code

• 600 Read Road St Cathrines, ON L2R 7K6
  Address

• Prepared by

• What is the source of the report?

  Select Service Request Quality Assurance Inspection Risk Assessment Internal Quality Audit Staff Observation Management Review Customer Complaint / Concern Trending Data HACCP Metal Detector

  • Service Request
  • Quality Assurance Inspection
  • Risk Assessment
  • Internal Quality Audit
  • Staff Observation
  • Management Review
  • Customer Complaint / Concern
  • Trending Data
  • HACCP
  • Metal Detector

• Was product involved? Y/N If yes notify SQFP immediately

  Yes

  No

  Not Product Related

• If Yes, Notify SQFP immediately

• Description of Deviation:

Product Safety

• Was Product Safety Compromised? If yes, SQFP completes the rest of this section

  Yes

  No

  Not Product Related

• Notify SQFP

  Yes

  No

  N/A

• Quantity Affected

• Lot Codes Affected

• Was Product Held?

  Yes

  No

  Not Product Related

• Why?

• Date & Time Product Was Placed on Hold

  Date

• Date Released:

  Date

Product Disposition:

• Product was reworked:

  Yes

  No

  N/A

• Product was destroyed:

  Yes

  No

  N/A

• Product was put back into stock:

  Yes

  No

  N/A

• Other

Corrective Action

• Immediate Corrective Action Taken:

  Yes

  No

  N/A

• Explain

• Explain

• Assigned To:

  Sign

• Completion Date:

  Date

• Was the Corrective Action Effective?

  Yes

  No

  N/A

• Explain

  Yes

  No

  N/A

• Explain

  Yes

  No

  N/A

• Description of Root Cause Analysis:

• Preventative Action Taken:

• Assigned To:

  Sign

• Completion Date:

  Date

• Preventative Action was Effective:

  Yes

  No

  N/A

• Explain

• Explain

  Yes

  No

  N/A

• Completed By:

  Sign

• Date:

  Date

• Management Verification

  Sign

• Date

  Date