Document No

Revision No
CORRECTIVE ACTION REPORT
Issue Date
Page No

Organization: Date: Location: Visit No: 1

Title: CAR Ref: Item Ref. Date to be Completed

by:

Part 1 Finding Description (Fault Identified):

Recommendations: Place any recommendations here:

Recommend the following:

Responsible Manager

Finding √ Non-
Observation Finding Category:
Low / Moderate
H
High / Extreme
Type Compliance Risk Risk

Part 2 Tick most appropriate root cause box: (to be completed in consultation with QA)
Task/education √ Inadequate Lack of Discipline Lack of resources/time
checking
Poor instruction/procedure Lack of training Poor work Lack of management
environment support
√ Not following procedures Poor planning Poor Lack of maintenance
communications
Lack of standard operating Design Unsuitable Other
procedures deficiency equipment

Auditors Name & signature: Date: 20 January 2017

Responsible Manager

I acknowledge receipt of this finding and will provide a response

Management/Representative signature:

Date:

Part 3 Responsible Manager to complete Parts 3

Immediate Action Date remedial action to be completed:

Responsible Manager: (Recipient to complete Parts 4and 5 then return to QA/QC Manager on or before response date)
Part 4 Corrective Action Date Corrective action to be completed:
 Document No
Revision No
CORRECTIVE ACTION REPORT
Issue Date
Page No

Part 5 Preventative Action Taken:

Responsible Manager
Action Completed by (Name): Title: Date:

....HSSE Manager to complete….

Part 6 Follow-up and close out Proposed follow-up date:

Auditor: Date CAR Closed out:

….GM/Senior Management review to complete….

Part 7 Review of Corrective and Preventative Action:

Corrective action is verified as effective. This CAR is :- Closed

Review Authority Name & Signature: Date CAR reviewed:

 CAR Register updated  Auditee advised

Site/location Manager: Date: