Title Page
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Company
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Address
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Quality Manager
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Date Issued
Supplier Corrective Action Request (SCAR) Form
General Information
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Supplier
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Part Name & Number
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PO/Lot Number
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Problem Description
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Photo Evidence
Action Response
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Containment action completed within 48 hours of SCAR issuance
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Actual completion date of containment action
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Photo evidence
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Person responsible for containment action
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Primary root cause(s) for reject occurrence
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What was done to prevent recurrence and/or defect?
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Implementation date of permanent corrective action
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Photo evidence
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Person responsible for permanent corrective action
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How will the effectivity of the corrective action be measured?
Completion
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Additional comments
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Quality Manager Name & Signature