Title Page

  • Manufacturing Facility
  • Business Unit

  • Quality Manager

  • Date Issued

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

Completion

  • Additional Comments

  • Quality Manager Name & Signature

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