Corrective Action Report

Principal Investigator

Details of Non-Conformity Identified

Add photo evidence of deficiency if applicable


Response to deficiency

Corrective Action Plan

Describe corrective action

Risk Matrix Reference




Risk Rating

Additional comments

Timeline of Implementation

Signature of Auditor
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.