CORRECTIVE/PREVENTIVE ACTION REQUEST (CAPA)

Dep.: Date: Doc. No.: CAR No.:

Interested Person
Internal Audit External Audit Manag. Review Customer Complaint Other

Non-Conformance Description

Auditor: Sig.: Auditee: Sig.:

MR: Sig.: Agree Disagree

Action Taken
Root Cause:

Proposed Corrective/Preventive Action:

Auditee: Sig.: Expected date:

MR: Sig.: Agree Disagree

Follow-up & Verification

Action Taken is enough Yes No Auditor: Sig.: Date:

Note & Remarks:

Action Taken is enough Yes No Auditor: Sig.: Date:

Doc No: SSI-CPA-Fo-01 Rev: 00 Issue date: 12/03/2017