PRODUCT COMPLAINT ASSESMENT

COMPLAINANT AND REPORT

DETAILS
Name of Complainant Date

Section / Department Contact Number

PRODUCT DETAILS
Product Name Strength

Manufacturer

Batch No. Expiry Date Pack Size

TYPE OF CONCERNS
COMPLAINT

- Product Appearance - Packaging - Product Instability - Product Elegance

- Break in Cold Chain - Labelling - Package Condition - Breakage
- Odour - Shelf-Life - Product Efficacy
- Others (please state) - Safety
- Others (please state)

Description of Complaint:

ADDITIONAL
INFORMATION
Please answer these -questions when appropriate.

Was seal on product broken when you received package? - Yes - No

Were other packages of same item examined? What was their condition?

Storage conditions (eg. Sunlight, heat, dampness, etc) and time period. Describe.

Complaint product submitted to D-CS? -Yes - No

Submitted by

Designation and Chop:

 FOR OFFICE USE ONLY

Products Description Correct - Yes - No

Sample Receipt - Yes - No

Description of Complaint (Additional Remarks)

ASSESSMENT OF COMPLAINT

- Complaint defined clearly

Reference Number Date

- Complaint not clearly defined

Investigate and make recommendation

CLASSIFICATION OF COMPLAINT (Please tick)

- Minor - Major - Critical

ACTION TAKEN

Name of Reporter:

Signature of Reporter:

Date: