CORRECTIVE & PREVENTIVE ACTION FORM

Item No No.

Description Date

Customer Qty.

Nature of Problem

1 Why :

2 Why :
Root
cause
Analysis 3 Why :

4 Why :

5 Why :

Possible corrective
Action

Corrective actions Resp

Implementation of
CA

Corrective actions Resp

Verification
of CA

Resp
Preventive
actions

Segregation of the lot

Qty
Segregated
Qty accepted

Disposition
action
 Target date

Disposition Scrap the material

action
Scrapped Qty.
Target date

Receive back from the

customer

Target date
 CAPA No: M-SF-25/2018

Photos

esp Target date

esp Target date

esp Target Date

Team Members

Name Department
 Customer

Problem closed

Date:
CORRECTIVE & PREVENTIVE ACTION FORM CAPA No: M-SF-25/2018

CATCHIN
Item No No. Photos
G LEVER

Description Date

Customer Qty.

Nature of
Problem Casting is break .

1 Why :

2 Why :
Root
cause
Analysis 3 Why :

4 Why :

5 Why :

Possible
corrective
Action

Target
Implemen Corrective actions Resp date
tation of
CA

Target
Verificatio Corrective actions Resp date
n
of CA

Target
Preventiv Resp Date
e
actions
Preventiv
e
actions

Segregation of the
lot Team Members
Qty
Segregat
ed Name
Qty
accepted
Target
date
Dispositio
n
Scrap the material
action
Scrapped
Qty.
Target
date

Receive back from

Problem closed
the customer
Date:
Target date
CAPA No: M-SF-25/2018

Photos
Team Members

Department

Customer

Problem closed