CORRECTIVE / PREVENTIVE DATE :

ACTION FORM
ISSUED BY (NAME SURNAME-SIGNED):

Audit (Internal/External) □
DESCRIPTION OF NONCONFORMITY:
Customer complaint □
Process Control □
Suggestion □

SUGGESTIONS FOR SOLUTIONS FOR CORRECTION OF NONCONFORMITY

CPA Required □
/ CONCLUSION: CPA Not Necessary □
APPROVAL (GM):

CPA NO :

CPA RESPONSIBLE / SIGNATURE:

ROOT CAUSE:

CORRECTIVE / PREVENTIVE ACTIONS TO BE TAKEN / TERMINAL:

ACTIVITIES:

CPA CLOSING DATE / ASSESSMENT:

CONFIRMATION

F.03.01/Rev.00