Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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CORRECTIVE ACTION REPORT
PLEASE SELECT A NEW REPORT FOR EACH INCIDENCE.
NEW REPORT
-
DATE:
-
DEPARTMENT:<br>(Select only ONE.)
-
NOTES:
-
EQUIPMENT: (Select only ONE)
- 1ST WASH TANK W SCREW
- 2ND WASH TANK WHITE CONVEYOR
- CHUTE #1
- CHUTE #2
- CHUTE NEW LINE
- CONTAINERS
- DESTONER
- DICER
- DRAIN
- FLOOR
- LARGE RESERVOIR WHITE BELT
- MANUAL FEEDER
- NEW PEELER
- PACKING MACHINE
- PARISIENNE MACHINE
- PEELER
- PIPES
- RESERVOIR WITH CONVEYOR
- ROLLER CONVEYOR
- SORTING TABLE
- TABLE
- THIRD TANK WITH GREY BELT
- WALLS
- WATER RESERVOIR WITH AUGER
- OTHER - SEE NOTES
-
NOTES:
-
ISSUES WITH EQUIPMENT: (Select all that apply.)
- DIRTY AFTER CLEANING
- WAS NOT CLEANED
- REPORT FILLED INCORRECTLY
- ITEM WAS NOT USED / CLEAN
- EQUIPMENT FAULTY / BROKEN
- EQUIPMENT NOT DISMANTLED
- OTHER - SEE ADDITIONAL NOTES
-
NOTES:
-
PLEASE SELECT CORRECTIVE ACTION TAKEN: (Select all that apply.)
- CLEANER INSTRUCTED IN PROPER PROCEDURES
- ITEM REWASHED
- NO ACTION REQUIRED AT THIS TIME
- INCIDENCE ADDRESSED WITH CLEANER IN QUESTION
- APPROPRIATE STAFF NOTIFIED OF DEFECT / BREAKAGE
- EQUIPMENT DISMANTLED
- RINSED AND SANITIZED
- SANITIZED ONLY
- FULL WASH AND SANITIZED
- OTHER - SEE ADDITIONAL NOTES
-
ADDITIONAL DETAILS: (Please provide any additional information that was not mentioned above.)
-
NAME OF CLEANER(S) INVOLVED:
-
SIGNATURE OF PCI SUPERVISOR ON DUTY:
-
CORRECTIVE ACTION REPORT
PLEASE SELECT A NEW REPORT FOR EACH INCIDENCE.
NEW REPORT
-
DATE:
-
DEPARTMENT:<br>(Select only ONE.)
-
NOTES:
-
EQUIPMENT: (Select only ONE)
- 1ST WASH TANK W SCREW
- 2ND WASH TANK WHITE CONVEYOR
- CHUTE #1
- CHUTE #2
- CHUTE NEW LINE
- CONTAINERS
- DESTONER
- DICER
- DRAIN
- FLOOR
- LARGE RESERVOIR WHITE BELT
- MANUAL FEEDER
- NEW PEELER
- PACKING MACHINE
- PARISIENNE MACHINE
- PEELER
- PIPES
- RESERVOIR WITH CONVEYOR
- ROLLER CONVEYOR
- SORTING TABLE
- TABLE
- THIRD TANK WITH GREY BELT
- WALLS
- WATER RESERVOIR WITH AUGER
- OTHER - SEE NOTES
-
NOTES:
-
ISSUES WITH EQUIPMENT: (Select all that apply.)
- DIRTY AFTER CLEANING
- WAS NOT CLEANED
- REPORT FILLED INCORRECTLY
- ITEM WAS NOT USED / CLEAN
- EQUIPMENT FAULTY / BROKEN
- EQUIPMENT NOT DISMANTLED
- OTHER - SEE ADDITIONAL NOTES
-
NOTES:
-
PLEASE SELECT CORRECTIVE ACTION TAKEN: (Select all that apply.)
- CLEANER INSTRUCTED IN PROPER PROCEDURES
- ITEM REWASHED
- NO ACTION REQUIRED AT THIS TIME
- INCIDENCE ADDRESSED WITH CLEANER IN QUESTION
- APPROPRIATE STAFF NOTIFIED OF DEFECT / BREAKAGE
- EQUIPMENT DISMANTLED
- RINSED AND SANITIZED
- SANITIZED ONLY
- FULL WASH AND SANITIZED
- OTHER - SEE ADDITIONAL NOTES
-
ADDITIONAL DETAILS: (Please provide any additional information that was not mentioned above.)
-
NAME OF CLEANER(S) INVOLVED:
-
SIGNATURE OF PCI SUPERVISOR ON DUTY:
-
CORRECTIVE ACTION REPORT
PLEASE SELECT A NEW REPORT FOR EACH INCIDENCE.
NEW REPORT
-
DATE:
-
DEPARTMENT:<br>(Select only ONE.)
-
NOTES:
-
EQUIPMENT: (Select only ONE)
- 1ST WASH TANK W SCREW
- 2ND WASH TANK WHITE CONVEYOR
- CHUTE #1
- CHUTE #2
- CHUTE NEW LINE
- CONTAINERS
- DESTONER
- DICER
- DRAIN
- FLOOR
- LARGE RESERVOIR WHITE BELT
- MANUAL FEEDER
- NEW PEELER
- PACKING MACHINE
- PARISIENNE MACHINE
- PEELER
- PIPES
- RESERVOIR WITH CONVEYOR
- ROLLER CONVEYOR
- SORTING TABLE
- TABLE
- THIRD TANK WITH GREY BELT
- WALLS
- WATER RESERVOIR WITH AUGER
- OTHER - SEE NOTES
-
NOTES:
-
ISSUES WITH EQUIPMENT: (Select all that apply.)
- DIRTY AFTER CLEANING
- WAS NOT CLEANED
- REPORT FILLED INCORRECTLY
- ITEM WAS NOT USED / CLEAN
- EQUIPMENT FAULTY / BROKEN
- EQUIPMENT NOT DISMANTLED
- OTHER - SEE ADDITIONAL NOTES
-
NOTES:
-
PLEASE SELECT CORRECTIVE ACTION TAKEN: (Select all that apply.)
- CLEANER INSTRUCTED IN PROPER PROCEDURES
- ITEM REWASHED
- NO ACTION REQUIRED AT THIS TIME
- INCIDENCE ADDRESSED WITH CLEANER IN QUESTION
- APPROPRIATE STAFF NOTIFIED OF DEFECT / BREAKAGE
- EQUIPMENT DISMANTLED
- RINSED AND SANITIZED
- SANITIZED ONLY
- FULL WASH AND SANITIZED
- OTHER - SEE ADDITIONAL NOTES
-
ADDITIONAL DETAILS: (Please provide any additional information that was not mentioned above.)
-
NAME OF CLEANER(S) INVOLVED:
-
SIGNATURE OF PCI SUPERVISOR ON DUTY:
-
CORRECTIVE ACTION REPORT
PLEASE SELECT A NEW REPORT FOR EACH INCIDENCE.
NEW REPORT
-
DATE:
-
DEPARTMENT:<br>(Select only ONE.)
-
NOTES:
-
EQUIPMENT: (Select only ONE)
- 1ST WASH TANK W SCREW
- 2ND WASH TANK WHITE CONVEYOR
- CHUTE #1
- CHUTE #2
- CHUTE NEW LINE
- CONTAINERS
- DESTONER
- DICER
- DRAIN
- FLOOR
- LARGE RESERVOIR WHITE BELT
- MANUAL FEEDER
- NEW PEELER
- PACKING MACHINE
- PARISIENNE MACHINE
- PEELER
- PIPES
- RESERVOIR WITH CONVEYOR
- ROLLER CONVEYOR
- SORTING TABLE
- TABLE
- THIRD TANK WITH GREY BELT
- WALLS
- WATER RESERVOIR WITH AUGER
- OTHER - SEE NOTES
-
NOTES:
-
ISSUES WITH EQUIPMENT: (Select all that apply.)
- DIRTY AFTER CLEANING
- WAS NOT CLEANED
- REPORT FILLED INCORRECTLY
- ITEM WAS NOT USED / CLEAN
- EQUIPMENT FAULTY / BROKEN
- EQUIPMENT NOT DISMANTLED
- OTHER - SEE ADDITIONAL NOTES
-
NOTES:
-
PLEASE SELECT CORRECTIVE ACTION TAKEN: (Select all that apply.)
- CLEANER INSTRUCTED IN PROPER PROCEDURES
- ITEM REWASHED
- NO ACTION REQUIRED AT THIS TIME
- INCIDENCE ADDRESSED WITH CLEANER IN QUESTION
- APPROPRIATE STAFF NOTIFIED OF DEFECT / BREAKAGE
- EQUIPMENT DISMANTLED
- RINSED AND SANITIZED
- SANITIZED ONLY
- FULL WASH AND SANITIZED
- OTHER - SEE ADDITIONAL NOTES
-
ADDITIONAL DETAILS: (Please provide any additional information that was not mentioned above.)
-
NAME OF CLEANER(S) INVOLVED:
-
SIGNATURE OF PCI SUPERVISOR ON DUTY:
-
CORRECTIVE ACTION REPORT
PLEASE SELECT A NEW REPORT FOR EACH INCIDENCE.
NEW REPORT
-
DATE:
-
DEPARTMENT:<br>(Select only ONE.)
-
NOTES:
-
EQUIPMENT: (Select only ONE)
- 1ST WASH TANK W SCREW
- 2ND WASH TANK WHITE CONVEYOR
- CHUTE #1
- CHUTE #2
- CHUTE NEW LINE
- CONTAINERS
- DESTONER
- DICER
- DRAIN
- FLOOR
- LARGE RESERVOIR WHITE BELT
- MANUAL FEEDER
- NEW PEELER
- PACKING MACHINE
- PARISIENNE MACHINE
- PEELER
- PIPES
- RESERVOIR WITH CONVEYOR
- ROLLER CONVEYOR
- SORTING TABLE
- TABLE
- THIRD TANK WITH GREY BELT
- WALLS
- WATER RESERVOIR WITH AUGER
- OTHER - SEE NOTES
-
NOTES:
-
ISSUES WITH EQUIPMENT: (Select all that apply.)
- DIRTY AFTER CLEANING
- WAS NOT CLEANED
- REPORT FILLED INCORRECTLY
- ITEM WAS NOT USED / CLEAN
- EQUIPMENT FAULTY / BROKEN
- EQUIPMENT NOT DISMANTLED
- OTHER - SEE ADDITIONAL NOTES
-
NOTES:
-
PLEASE SELECT CORRECTIVE ACTION TAKEN: (Select all that apply.)
- CLEANER INSTRUCTED IN PROPER PROCEDURES
- ITEM REWASHED
- NO ACTION REQUIRED AT THIS TIME
- INCIDENCE ADDRESSED WITH CLEANER IN QUESTION
- APPROPRIATE STAFF NOTIFIED OF DEFECT / BREAKAGE
- EQUIPMENT DISMANTLED
- RINSED AND SANITIZED
- SANITIZED ONLY
- FULL WASH AND SANITIZED
- OTHER - SEE ADDITIONAL NOTES
-
ADDITIONAL DETAILS: (Please provide any additional information that was not mentioned above.)
-
NAME OF CLEANER(S) INVOLVED:
-
SIGNATURE OF PCI SUPERVISOR ON DUTY:
-
CORRECTIVE ACTION REPORT
PLEASE SELECT A NEW REPORT FOR EACH INCIDENCE.
NEW REPORT
-
DATE:
-
DEPARTMENT:<br>(Select only ONE.)
-
NOTES:
-
EQUIPMENT: (Select only ONE)
- 1ST WASH TANK W SCREW
- 2ND WASH TANK WHITE CONVEYOR
- CHUTE #1
- CHUTE #2
- CHUTE NEW LINE
- CONTAINERS
- DESTONER
- DICER
- DRAIN
- FLOOR
- LARGE RESERVOIR WHITE BELT
- MANUAL FEEDER
- NEW PEELER
- PACKING MACHINE
- PARISIENNE MACHINE
- PEELER
- PIPES
- RESERVOIR WITH CONVEYOR
- ROLLER CONVEYOR
- SORTING TABLE
- TABLE
- THIRD TANK WITH GREY BELT
- WALLS
- WATER RESERVOIR WITH AUGER
- OTHER - SEE NOTES
-
NOTES:
-
ISSUES WITH EQUIPMENT: (Select all that apply.)
- DIRTY AFTER CLEANING
- WAS NOT CLEANED
- REPORT FILLED INCORRECTLY
- ITEM WAS NOT USED / CLEAN
- EQUIPMENT FAULTY / BROKEN
- EQUIPMENT NOT DISMANTLED
- OTHER - SEE ADDITIONAL NOTES
-
NOTES:
-
PLEASE SELECT CORRECTIVE ACTION TAKEN: (Select all that apply.)
- CLEANER INSTRUCTED IN PROPER PROCEDURES
- ITEM REWASHED
- NO ACTION REQUIRED AT THIS TIME
- INCIDENCE ADDRESSED WITH CLEANER IN QUESTION
- APPROPRIATE STAFF NOTIFIED OF DEFECT / BREAKAGE
- EQUIPMENT DISMANTLED
- RINSED AND SANITIZED
- SANITIZED ONLY
- FULL WASH AND SANITIZED
- OTHER - SEE ADDITIONAL NOTES
-
ADDITIONAL DETAILS: (Please provide any additional information that was not mentioned above.)
-
NAME OF CLEANER(S) INVOLVED:
-
SIGNATURE OF PCI SUPERVISOR ON DUTY:
-
CORRECTIVE ACTION REPORT
PLEASE SELECT A NEW REPORT FOR EACH INCIDENCE.
NEW REPORT
-
DATE:
-
DEPARTMENT:<br>(Select only ONE.)
-
NOTES:
-
EQUIPMENT: (Select only ONE)
- 1ST WASH TANK W SCREW
- 2ND WASH TANK WHITE CONVEYOR
- CHUTE #1
- CHUTE #2
- CHUTE NEW LINE
- CONTAINERS
- DESTONER
- DICER
- DRAIN
- FLOOR
- LARGE RESERVOIR WHITE BELT
- MANUAL FEEDER
- NEW PEELER
- PACKING MACHINE
- PARISIENNE MACHINE
- PEELER
- PIPES
- RESERVOIR WITH CONVEYOR
- ROLLER CONVEYOR
- SORTING TABLE
- TABLE
- THIRD TANK WITH GREY BELT
- WALLS
- WATER RESERVOIR WITH AUGER
- OTHER - SEE NOTES
-
NOTES:
-
ISSUES WITH EQUIPMENT: (Select all that apply.)
- DIRTY AFTER CLEANING
- WAS NOT CLEANED
- REPORT FILLED INCORRECTLY
- ITEM WAS NOT USED / CLEAN
- EQUIPMENT FAULTY / BROKEN
- EQUIPMENT NOT DISMANTLED
- OTHER - SEE ADDITIONAL NOTES
-
NOTES:
-
PLEASE SELECT CORRECTIVE ACTION TAKEN: (Select all that apply.)
- CLEANER INSTRUCTED IN PROPER PROCEDURES
- ITEM REWASHED
- NO ACTION REQUIRED AT THIS TIME
- INCIDENCE ADDRESSED WITH CLEANER IN QUESTION
- APPROPRIATE STAFF NOTIFIED OF DEFECT / BREAKAGE
- EQUIPMENT DISMANTLED
- RINSED AND SANITIZED
- SANITIZED ONLY
- FULL WASH AND SANITIZED
- OTHER - SEE ADDITIONAL NOTES
-
ADDITIONAL DETAILS: (Please provide any additional information that was not mentioned above.)
-
NAME OF CLEANER(S) INVOLVED:
-
SIGNATURE OF PCI SUPERVISOR ON DUTY:
-
CORRECTIVE ACTION REPORT
PLEASE SELECT A NEW REPORT FOR EACH INCIDENCE.
NEW REPORT
-
DATE:
-
DEPARTMENT:<br>(Select only ONE.)
-
NOTES:
-
EQUIPMENT: (Select only ONE)
- 1ST WASH TANK W SCREW
- 2ND WASH TANK WHITE CONVEYOR
- CHUTE #1
- CHUTE #2
- CHUTE NEW LINE
- CONTAINERS
- DESTONER
- DICER
- DRAIN
- FLOOR
- LARGE RESERVOIR WHITE BELT
- MANUAL FEEDER
- NEW PEELER
- PACKING MACHINE
- PARISIENNE MACHINE
- PEELER
- PIPES
- RESERVOIR WITH CONVEYOR
- ROLLER CONVEYOR
- SORTING TABLE
- TABLE
- THIRD TANK WITH GREY BELT
- WALLS
- WATER RESERVOIR WITH AUGER
- OTHER - SEE NOTES
-
NOTES:
-
ISSUES WITH EQUIPMENT: (Select all that apply.)
- DIRTY AFTER CLEANING
- WAS NOT CLEANED
- REPORT FILLED INCORRECTLY
- ITEM WAS NOT USED / CLEAN
- EQUIPMENT FAULTY / BROKEN
- EQUIPMENT NOT DISMANTLED
- OTHER - SEE ADDITIONAL NOTES
-
NOTES:
-
PLEASE SELECT CORRECTIVE ACTION TAKEN: (Select all that apply.)
- CLEANER INSTRUCTED IN PROPER PROCEDURES
- ITEM REWASHED
- NO ACTION REQUIRED AT THIS TIME
- INCIDENCE ADDRESSED WITH CLEANER IN QUESTION
- APPROPRIATE STAFF NOTIFIED OF DEFECT / BREAKAGE
- EQUIPMENT DISMANTLED
- RINSED AND SANITIZED
- SANITIZED ONLY
- FULL WASH AND SANITIZED
- OTHER - SEE ADDITIONAL NOTES
-
ADDITIONAL DETAILS: (Please provide any additional information that was not mentioned above.)
-
NAME OF CLEANER(S) INVOLVED:
-
SIGNATURE OF PCI SUPERVISOR ON DUTY:
-
CORRECTIVE ACTION REPORT
PLEASE SELECT A NEW REPORT FOR EACH INCIDENCE.
NEW REPORT
-
DATE:
-
DEPARTMENT:<br>(Select only ONE.)
-
NOTES:
-
EQUIPMENT: (Select only ONE)
- 1ST WASH TANK W SCREW
- 2ND WASH TANK WHITE CONVEYOR
- CHUTE #1
- CHUTE #2
- CHUTE NEW LINE
- CONTAINERS
- DESTONER
- DICER
- DRAIN
- FLOOR
- LARGE RESERVOIR WHITE BELT
- MANUAL FEEDER
- NEW PEELER
- PACKING MACHINE
- PARISIENNE MACHINE
- PEELER
- PIPES
- RESERVOIR WITH CONVEYOR
- ROLLER CONVEYOR
- SORTING TABLE
- TABLE
- THIRD TANK WITH GREY BELT
- WALLS
- WATER RESERVOIR WITH AUGER
- OTHER - SEE NOTES
-
NOTES:
-
ISSUES WITH EQUIPMENT: (Select all that apply.)
- DIRTY AFTER CLEANING
- WAS NOT CLEANED
- REPORT FILLED INCORRECTLY
- ITEM WAS NOT USED / CLEAN
- EQUIPMENT FAULTY / BROKEN
- EQUIPMENT NOT DISMANTLED
- OTHER - SEE ADDITIONAL NOTES
-
NOTES:
-
PLEASE SELECT CORRECTIVE ACTION TAKEN: (Select all that apply.)
- CLEANER INSTRUCTED IN PROPER PROCEDURES
- ITEM REWASHED
- NO ACTION REQUIRED AT THIS TIME
- INCIDENCE ADDRESSED WITH CLEANER IN QUESTION
- APPROPRIATE STAFF NOTIFIED OF DEFECT / BREAKAGE
- EQUIPMENT DISMANTLED
- RINSED AND SANITIZED
- SANITIZED ONLY
- FULL WASH AND SANITIZED
- OTHER - SEE ADDITIONAL NOTES
-
ADDITIONAL DETAILS: (Please provide any additional information that was not mentioned above.)
-
NAME OF CLEANER(S) INVOLVED:
-
SIGNATURE OF PCI SUPERVISOR ON DUTY:
-
CORRECTIVE ACTION REPORT
PLEASE SELECT A NEW REPORT FOR EACH INCIDENCE.
NEW REPORT
-
DATE:
-
DEPARTMENT:<br>(Select only ONE.)
-
NOTES:
-
EQUIPMENT: (Select only ONE)
- 1ST WASH TANK W SCREW
- 2ND WASH TANK WHITE CONVEYOR
- CHUTE #1
- CHUTE #2
- CHUTE NEW LINE
- CONTAINERS
- DESTONER
- DICER
- DRAIN
- FLOOR
- LARGE RESERVOIR WHITE BELT
- MANUAL FEEDER
- NEW PEELER
- PACKING MACHINE
- PARISIENNE MACHINE
- PEELER
- PIPES
- RESERVOIR WITH CONVEYOR
- ROLLER CONVEYOR
- SORTING TABLE
- TABLE
- THIRD TANK WITH GREY BELT
- WALLS
- WATER RESERVOIR WITH AUGER
- OTHER - SEE NOTES
-
NOTES:
-
ISSUES WITH EQUIPMENT: (Select all that apply.)
- DIRTY AFTER CLEANING
- WAS NOT CLEANED
- REPORT FILLED INCORRECTLY
- ITEM WAS NOT USED / CLEAN
- EQUIPMENT FAULTY / BROKEN
- EQUIPMENT NOT DISMANTLED
- OTHER - SEE ADDITIONAL NOTES
-
NOTES:
-
PLEASE SELECT CORRECTIVE ACTION TAKEN: (Select all that apply.)
- CLEANER INSTRUCTED IN PROPER PROCEDURES
- ITEM REWASHED
- NO ACTION REQUIRED AT THIS TIME
- INCIDENCE ADDRESSED WITH CLEANER IN QUESTION
- APPROPRIATE STAFF NOTIFIED OF DEFECT / BREAKAGE
- EQUIPMENT DISMANTLED
- RINSED AND SANITIZED
- SANITIZED ONLY
- FULL WASH AND SANITIZED
- OTHER - SEE ADDITIONAL NOTES
-
ADDITIONAL DETAILS: (Please provide any additional information that was not mentioned above.)
-
NAME OF CLEANER(S) INVOLVED:
-
SIGNATURE OF PCI SUPERVISOR ON DUTY: