Title Page
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Conducted on
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Prepared by
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Location
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Date:
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ANALYSIS
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Report initiator:
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Report owner:
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Origination:
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Customer complaint
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Public complaint
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Non conforming product
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Audit / inspection finding
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Category:
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Non conformance
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Controllable action
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Improvement action
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Major
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High risk
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System
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Moderate
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Medium risk
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Process
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Minor
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Low risk
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Other
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Description:
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Corrective action
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Briefly describe how you intend to remove the immediate problem
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Corrective action
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Date due
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Verification
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(completion & closeout)
Corrective action
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Date due
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Name
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Date
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ASAP
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Preventive action
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Briefly describe how you intend to stop the problem happening again
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Preventive action
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Date due
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Verification
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(completion & closeout)
Preventive action
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Date due
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Name
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Date
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Corrective and preventive action completion (report owner)
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Print name
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Signature
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Date
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Report owner:
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Ben Smith
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Line manager:
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Closeout (report initiator)
Actions adequate?
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If NO, re-issue to the report owner detailing reasons for rejection below
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Print name
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Signature
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Date
