List your Enter full name of

processes here: CAR form here

Process 1
Process 2 Enter abbreviated
Etc.
If you have only 10 name of your CAR
processes or less, just fill in form here
the names and use the
"CAR Form - Checkbox"
version of the form.

Enter name or title of

CAR Administrator
here
If you have more than 10
processes, you may list add
as many as you like, but
use the "CAR Form -
Dropdown" version of the
form instead.
 For example, "Corrective Action Request" Corrective Action (existing issue)
Preventive Action (potential issue)
Opportunity for Improvement / Suggestion

For example, "CAR"

For example, "John Smith" or "QA Manager"

Employee Feedback Low
Customer Feedback Medium
Supplier / Subcontractor Feedback High
External Audit Finding Urgent / Critical
Internal Audit Finding
Management Review Action Item
 #
() - Rev 0
00
00
Type of Action: Name:
Source of Request: Date:
Process Affected:
Priorty:
Describe the issue or problem in detail.

Stop here. Submit to

Assigned to: Date Assigned: Respond by:

To be completed by the Assignee.
Root Cause of Problem: (Required for all corrective and preventive issues; optional for suggestions for improvement.)

Action Plan: (Actions taken to eliminate root cause, resolve issue and prevent recurrence.)

Date Action Completed: Name:

Stop here. Return to

Effectiveness verified by: Date:

Result: PASS FAIL: Returned for Further Processing

Notes and
justification:
 #
() - Rev 0
00
00
Type Corrective Action (existing issue) Preventive Action (potential issue) Name:
Check one
Opportunity for Improvement / Suggestion Date:

Employee Feedback Customer Feedback Supplier / Subcontractor Feedback

Source External Audit Internal Audit
Management Review Action Item
Check one Finding Finding
Other:

Process 1 Process 2 Etc.

Process 0 0 0
Check one 0 0 0
0 Other:

Priority Low Medium High Urgent / Critical

Check One

Describe the issue or problem in detail.

Stop here. Submit to

Assigned to: Date Assigned: Respond by:

To be completed by the Assignee.
Root Cause of Problem: (Required for all corrective and preventive issues; optional for suggestions for improvement.)

Action Plan: (Actions taken to eliminate root cause, resolve issue and prevent recurrence.)

Date Action Completed: Name:

Stop here. Return to

Effectiveness verified by: Date:

Result: PASS FAIL: Returned for Further Processing
Notes and
justification: