Report No.

CORRECTIVE ACTION REPORT (CAR) 2005-QC-08-001

Type of Problem  Product/Part Process Int.Audit Service Delivery SPC Vendor Others
Please Tick  the Appropriate Box
Item Code Lot No. Quantity Produced Rejected Quantity

Problem : Disposition of NonConforming Product/Part:

Rework Sort Out Return To ______
ISSUER

Accepted Scrap Others_______

Date Approved by
Recur? (Y/N) No of Problem(s) Attached Samples Data Report

This report is to be responded within : 3 days 6 days 10 days ____ days

Date Issued By Approved By
Issue To : _____________ Due Date :11-August-2005
_____________

1.Team Leader : Members :

2.Problem Analysis (Suggest to Use 5W 2H Process Flowchart, etc)

3.Immediate Containment Action(s) Implementation Date Responsible By Verification Result

(Quantify Result)

Production Result attached.

4.Root Cause(s), occurrence & outflow Please Tick  the Appropriate Box 5.Verification Result (Y/N) Responsible By
Men Machine Method Material Environment Design
RESPONSIBLE PARTY

6. Corrective Action(s), occurrence & outflow Responsible By Implementation Date

6.1 Mistake Proofing Action ( Consider Checklist, Automation, Detector, etc )

7.Prevent Recurrence (Consider Change of Standard, Process , Design etc / Is It Applicable To Similar Products/Lines? Responsible By Implementation Date

Date Reported By Approved By

8.Effectiveness Review/Verify Corrective Action

ISSUER

Date Specify By Approved By

Method : Review after _____ lot(s)/ _____day(s)/week(s)/mth(s).
Issuing Section to Stipulate Review Period and Copy to Responsible Section

Result :
Before : After:
ISSUER & RESPONSIBLE

Conclusion : OK / NG. Comment (if any) Date Reported By Approved By

If NG, Reissue: Yes /No

Use additional sheet(s) if necessary

NPCB-FM-08-QC-023, Rev.0,P1/1 PT.SOC BATAM