Republic of the Philippines

Department of Health
FOOD AND DRUG ADMINISTRATION
Filinvest Corporate City
Alabang, City of Muntinlupa

RFO/CO:_____________________

CORRECTIVE ACTION AND PREVENTIVE ACTION PLAN

Name of Establishment: Address:

Inspector/s: Inspection dates:

Prepared by : Date prepared (dd/mm/yyyy):

(Name & Designation of establishment’s authorized representative)

Note: Establishment to fill columns 3 to 5.

Completion or Response
Deficiency Corrective Action /Preventive Inspector(‘s)
Description of deficiency Evidence of compliance proposed completion accepted
number Actions (CAPA) date dd/mm/yyyy
Comment(s)
(2) (4) (Yes / No)
(1) (3) (5) (6)
(7)
CRITICAL

MAJOR

OTHERS

Date Effective: 02 July 2018 Rev 01

Form No. QWP-FROO-06 Annex 28 Corrective Action and Preventive Action Plan Page 1 of 3
 Republic of the Philippines
Department of Health
FOOD AND DRUG ADMINISTRATION
Filinvest Corporate City
Alabang, City of Muntinlupa

Completion or Response
Deficiency Corrective Action /Preventive Inspector(‘s)
Description of deficiency Evidence of compliance proposed completion accepted
number Actions (CAPA) date dd/mm/yyyy
Comment(s)
(2) (4) (Yes / No)
(1) (3) (5) (6)
(7)

For FDA use only:

Remarks

Recommendation(to FDA office):

Date Effective: 02 July 2018 Rev 01

Form No. QWP-FROO-06 Annex 28 Corrective Action and Preventive Action Plan Page 2 of 3
 Republic of the Philippines
Department of Health
FOOD AND DRUG ADMINISTRATION
Filinvest Corporate City
Alabang, City of Muntinlupa

Reviewed Name /Designation and Signature of FDRO(s) Date:

by:

Date:
Noted by: Name and Signature Team Leader/Supervisor

Date Effective: 02 July 2018 Rev 01

Form No. QWP-FROO-06 Annex 28 Corrective Action and Preventive Action Plan Page 3 of 3