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Doc No.

Issue status 00
Revision status 02
Author
CORRECTIVE AND PREVENTIVE ACTION Date
REPORT Page 1 of 1

Source of CAPA
Date
Problem No.

Problem description

Problem Identified By:


Root Causes

Corrective / Preventive action


S.No Corrective Action By Whom By Date

Whether Preventive Action is required  Yes  No


S.No Preventive Action By Whom By Date

Closure Remarks NC closed


Approved By & Date:
Comments:

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