Supplier Corrective Action Report Form

General Information

Supplier Name & ID Number

Supplier Representative Name & Email Address

Part Name & Number

Quantity Rejected

Description of the Problem

Investigation for Root Cause

Did you go to the place where the work is performed and review the process (gemba)?

Did you review work instructions and procedures?

Did you talk to employees involved with this process?

Is the requirement adequately defined and documented?

Have any changes been implemented around the time of this defect for process(es) related to this defect?

Is tooling & fixtures, process sequencing, and storage/handling of material complete?

Direct Cause

What is the root cause for the technical problem that caused the nonconformity?

Detection Cause

How did the non-conformance escape the process? Why did the quality system fail to detect the non-conformance?

Systemic Cause

How did the product development/production/support processes contribute to the problem?

Has the root cause identified a fundamental breakdown or failure of a process?

Has the element of the process that caused the root cause been corrected?

Permanent Corrective Actions & Recurrence Prevention
Corrective Action

Activity Type

Detailed Description of Corrective Action

Name & Title of Person Responsible

Expected Completion Date
Objective Evidence after Completion

Additional Comments

Quality Manager Name & Signature
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.