Audit

1. Originator

Name:

Position:

Report Type:

Report Origin:

Description of Non-conformance or Opportunity for Improvement request:

Shore-based Manager:

Response Date:
Master's Signature:
Date:

WHEN COMPLETE, SEND TO SHORE-BASED MANAGER

2. Shore-based Manager - Proposed Action

For Corrective/Preventative Actions, please indicate:

Root Cause of Problem

Proposed Corrective/Preventative Action:

Proposed Completion Date

Disposition

Date:
Copy to Designated Person - Designated Person Signature
Date:

Description of Action(s) taken:

Completion Date:
Shore-based Manager's Signature

SEND BACK TO MASTER FOR QUALITY ASSURANCE FOLLOW UP

3. Quality Assurance - Master Follow up

Problems successfully addressed?

Signature:
Date:
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.