No. Formulir : PPD.PPC.SMM.FORM.822.

004
Edisi : 1
Revisi : 2
Tanggal Efektif : 15 September 2009
Halaman : 1 dari 1

CORRECTIVE ACTION REQUEST

PT. PLN (PERSERO)
SEKTOR PEMBANGKITAN
PLTGU CILEGON CORECTIVE ACTION REQUEST (CAR)
BAGIAN : CAR NO. :
TANGGAL AUDIT : AUDITEE :
AUDITOR :
RINCIAN TEMUAN : Minor Major Rekom.
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…………………………………………………………………………………………………………….. Batas waktu penyelesaian
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Tanggal :

TANDA TANGAN TANDA TANGAN

AUDITEE: AUDITOR : LEAD AUDITOR:

1. Identifikasi Penyebab :
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2. Tindakan Perbaikan / Pencegahan :
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3. Dokumen terkait yang harus direvisi :
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Tanggal penyelesaian :
Verifikasi terhadap tindakan perbaikan / pencegahan :
…………………………………………………………………………………………………. Keputusan :
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…………………………………………………………………………………………………. Selesai
…………………………………………………………………………………………………. Terbit CAR baru No.
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Tanda Tangan Tanggal Verifikasi :
AUDITOR: