Doc. No.

:
COMPANY
Revison No. :

CORRECTIVE ACTION REQUEST (CAR) FORM Page :

PART 1 : AUDIT INFORMATION

AUDIT REPORT NO. : LEAD AUDITOR :

AUDIT DATE : AUDITOR :

CAR NO :

COMPANY : AUDITEE :

DEPARTMENT :

PART 2 : REFERENCES STANDARD/DOCUMENTS

PART 3 : AUDIT FINDINGS (to be completed by the Auditor)

Details of Non-Conformance / Observation :

Subject :

Prepared by:
Date:

PART 4 : PROPOSED CORRECTIVE ACTION (to be completed by the Auditee)

Noted : To include investigation to identify the root cause of the problem Target Close-Out Date :

Investigation/Cause of Non-Conformities : Prepared by (Auditee)

Correction/Immediate Action

Signature
Name:
Date:

Reviewed/Accepted by (Auditor)

Corrective Action

Signature
Name:
Date:

PART 5 : VERIFICATION AND FOLLOW-UP (to be completed by the Auditor)

Close-Out Status

YES NO

Date Closed :

Close-Out by (Auditor)

Signature
Name:
Date: