Template

CORRECTIVE AND PREVENTIVE ACTION REQUEST

A. AUDITED AREA/DEPARTMENT:
Date:

Issued by:

Issued to :

Date:

B. DESCRIPTION OF NON-CONFORMANCE & EVIDENCE

C. ROOT CAUSE ANALYSIS

NC -

Evidence -

Audit Criteria: Internal Procedure

D. CORRECTIVE ACTION:

Date of Implementation:
E. PREVENTIVE ACTION:

Date of Implementation:
F. VERIFICATION:

Date of Verification:
Auditor (Signature)

QUALITY ASSURANCE DEPARTMENT

DATE:

Created by Jean Francois Laurette