Title Page

  • Incident/Document#

  • Incident Date

  • Product Code

  • 600 Read Road St Cathrines, ON L2R 7K6
  • Prepared by

Corrective Action Report

  • What is the source of the report?

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

  • If Yes, Notify SQFP immediately

  • Description of Deviation:

Product Safety

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

  • Notify SQFP

  • Quantity Affected

  • Lot Codes Affected

  • Was Product Held?

  • Why?

  • Date & Time Product Was Placed on Hold

  • Date Released:

Product Disposition:

  • Product was reworked:

  • Product was destroyed:

  • Product was put back into stock:

  • Other

Corrective Action

  • Immediate Corrective Action Taken:

  • Explain

  • Explain

  • Assigned To:

  • Completion Date:

  • Was the Corrective Action Effective?

  • Explain

  • Explain

  • Description of Root Cause Analysis:

  • Preventative Action Taken:

  • Assigned To:

  • Completion Date:

  • Preventative Action was Effective:

  • Explain

  • Explain

  • Completed By:

  • Date:

Verification

  • Management Verification

  • Date

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