Information

  • Document No.

  • Title:

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel involve:

Detail Department

  • Department / Lifecycle / Proses / Activity / Services :

  • Date review / establish:

  • Reason to review

  • Reviewer:

Detail Performance Measure

  • Aspect to focus

  • Detail description of Aspect
  • Type of Organization Context

  • Elaborate:

  • Aspect
  • Effect on Management System

  • Risk

  • Effect on Process

  • Risk

  • Opportunity Assessment (What can be done?)

  • Objective

  • Target (Measurable)

  • Program Initiate
  • Detail of the program

  • Due date:

  • Departmental Program?

  • Indicator

  • Indicator (Status):

  • Data to Monitor and Measure

  • Person in charge:

  • Status of the Program

Residual Risk

  • Verify Corrective Action Effectiveness

  • Person verify

  • Significant Risk

Department Head/Representative Approval

  • Approved by:

  • Remark:

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