Organization:

SPRINTECH
Corrective and Preventive

Doc. Title:

Action Form
STP/FRM-012

Document Code:

Rev#: 00

CPA No (to be filled by MR): ___________

CPA Initiated on (Date): __________

CPA Initiated by (Name):

______________

CPA Initiated due to (Please tick relevant appropriate box below):

Non-Conformance

Complaint

Air Emission

Internal Audit

Suggestion / Improvement

Spillage/Effluents
Hazard

Process/Quality Deviation
Date: ________

Shift: __________

Department: __________

Machine:

Incharge: __________

Operator:___________

A. Description (to be filled by Initiator)

Signatures

Accepted
Rejected:

MR_______________ Marked to: ___________________ Date: _________

* If accepted then MR to mark it to concerned dept for Analysis.

B. Root Cause Analysis

C. Proposed Corrective & Preventive Action

Target Date :

.
Name & Signatures
(Person who carried out Root Cause Analysis and Proposed Corrective & Preventive Action)

D. Verification by the MR for Implementation & Effectiveness

Is Proposed Action Implemented: YES
Is it Effective: YES NO
NO

Organization:

SPRINTECH
Corrective and Preventive

Doc. Title:

Action Form
Document Code:

STP/FRM-012

Rev#: 00

Comments (if any):

________________________________________________________________
________________________________________________________________________________
CPA closing date: _______________

MR Sign: _____________________