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Corrective/ Preventive Action Request Form

CPA #
1. Problem Identification
Problem Identified By Date:
Name: Designation:
Problem Description:

2. Root Cause Identification


Root Cause Found:

3. Corrective Action Implementation

4. Preventive Action Implementation

Implementation Date: Verified By:

5. Follow up

Signature:
If not verified raise new CAR

_______________________
Management Representative Date____________________

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