Title Page
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Manufacturing Facility
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Business Unit
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Quality Manager
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Date Issued
Supplier Corrective Action Report Form
General Information
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Supplier Name & ID Number
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Supplier Representative Name & Email Address
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Part Name & Number
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Quantity Rejected
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Description of the Problem
Investigation for Root Cause
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Did you go to the place where the work is performed and review the process (gemba)?
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Did you review work instructions and procedures?
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Did you talk to employees involved with this process?
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Is the requirement adequately defined and documented?
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Have any changes been implemented around the time of this defect for process(es) related to this defect?
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Is tooling & fixtures, process sequencing, and storage/handling of material complete?
Direct Cause
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What is the root cause for the technical problem that caused the nonconformity?
Detection Cause
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How did the non-conformance escape the process? Why did the quality system fail to detect the non-conformance?
Systemic Cause
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How did the product development/production/support processes contribute to the problem?
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Has the root cause identified a fundamental breakdown or failure of a process?
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Has the element of the process that caused the root cause been corrected?
Permanent Corrective Actions & Recurrence Prevention
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Corrective Action
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Activity Type
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Detailed Description of Corrective Action
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Name & Title of Person Responsible
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Expected Completion Date
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Objective Evidence after Completion
Completion
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Additional Comments
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Quality Manager Name & Signature