PT.
AKURA BINA CITRA
CORRECTIVE AND PREVENTIVE ACTION REQUEST FORM
CPAR No. #012/2018
Date Issued:
November 10, 2018
Affected Department /
Person In Charge
Problem Description
Reference Detail
(Fill where applicable)
Reference Standard /
Procedure
Cause of Problem
Action Needed
Corrective / Preventive
Action
(Use other paper if it is not
sufficient)
Action to prevent
recurrence / occurrence
of problem
(Use other paper if it is not
sufficient)
Proposed by,
Name: Andi Setyo Budianto
Position: QHSE Manager
Date: December 08, 2018
Management of Change :
Reviewing the
effectiveness of corrective
/ preventive action
Additional Notes
Form No.: 6.4
SPK No. # Internal Quality Audit
Requested Company/ by: Issued to (company or title): Target of Response Time:
Operations Director FS, Marketing, QHSE December 10, 2018
FS, Marketing, QHSE
BS EN 12079 1,2,3 has been obselete and change the standart to BS EN 10855
1,2,3 but still found some of contract order review, service report & report
v Service System Part / Equipment
Internal Audit:
Customer Complaint:
Contract / Work Order No:
Purchase Order No.:
Inspection Report No.:
Part/Equipment No.:
Other:
Cannot find softcopy and or hardcopy of this standard
Corrective Action Preventive Action
Completion Date:
Buy standard and or trying to download from free
Evidence Document:
providers
Completion Date:
Training & indoctriation Evidence Document:
Reviewed and Approved by, Closing Out Verified by,
Name: Ariani Widiawati Name: Ariani Widiawati
Position: Operations Director Position: Operations Director
Date: December 30, 2018 Date:
Yes No Effective Date :
Verified by
Date Verification
Remarks Effective / Not Effective / Repetitive
Rev. No.: 01 Date Issued : 05/01/2015