CORRECTIVE / PREVENTIVE

ACTION REPORT

PROJECT LOGO

VERIFICATIONAPPROVAL STEP 3: CAUSES AND ACTIONSTEP 2 : ANALYSIS OF

STEP 1 : IDENTIFICATION

[SERIAL NUMBER]

CORRECTIVE ACTION

PREVENTIVE ACTION

ISSUER
Company /
Subcontractor:
Name:

Position:

Date:

Signature:

Situation (NCR or
potential NCR)
needing Corrective or
Preventive Action:
Works
concerned:

Relevant NCRs
(if any):
ROOT
CAUSE(S):

CORRECTIVE /
PREVENTIVE
ACTION TO BE
TAKEN (based
on the analysis
of the causes):
DEADLINE FOR IMPLEMENTATION OF ACTION:

Person Responsible for Action:

Name:

Position:

Name:
Position:
Date:
Signature:

ACTUAL DATE OF ACTION TAKEN:

Person Responsible for Action:

Name:

Please attach evidence of action taken, for final closure.

WWW.QUALITYINCONSTRUCTION.COM

Date:

Signature:

PROJECT LOGO

CORRECTIVE / PREVENTIVE
ACTION REPORT

EVALUATIONSTEP 4 : VERIFICATION &

[SERIAL NUMBER]

Assessment of the effectiveness of the action (the evaluation should be performed within an
agreed period of time as specified in the relative procedure):
0 (not effective)
Comments:

Name:

WWW.QUALITYINCONSTRUCTION.COM

5 (very effective)

Position:

Date:

Signature: