Title Page

  • Company

  • Address
  • Quality Manager

  • Date Issued

Supplier Corrective Action Request (SCAR) Form

General Information

  • Supplier

  • Part Name & Number

  • PO/Lot Number

  • Problem Description

  • Photo Evidence

Action Response

  • Containment action completed within 48 hours of SCAR issuance

  • Actual completion date of containment action

  • Photo evidence

  • Person responsible for containment action

  • Primary root cause(s) for reject occurrence

  • What was done to prevent recurrence and/or defect?

  • Implementation date of permanent corrective action

  • Photo evidence

  • Person responsible for permanent corrective action

  • How will the effectivity of the corrective action be measured?


  • Additional comments

  • Quality Manager Name & Signature

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