‫نموذج عدم المطابقة‬

Section I: Report identification

Date CAPA No.

Department
Source of CAPA Report
Nonconformity from External Audit Nonconformity from Internal Audit
Nonconforming Material Report Customer Feedback
Management Review Evaluation of Compliance Result
HS&E Check Opportinity for Improvement
Other <If other please specify>.

Section II: Description of Nonconformity / Potential Nonconformity / opportunity for

improvement
<This section should be completed by the person how detect Nonconformity/Potential Nonconformity/ opportunity
for improvement>
Description:

Requirement <Clause> Reference <Clause Number>

Major
Classification of Minor Opportunity for
nonconformit
nonconformity point nonconformity improvement
y
Name Job title Signature Date

Section III: Analysis of Nonconformity/Potential Nonconformity

< This section should be completed by process owner>

Root cause of nonconformity/potential nonconformity

Lack of Awareness Lack of Documentation Equipment Deficiency
Lack of Implementation Lack of Supervision Process Deficiency
Humman Error Other < If other please specify>

Name Job title Signature Date

Code: QA-P-05/F01 Issue date 17/10.2019 Rev. 01 Page 1 of 2

 ‫نموذج عدم المطابقة‬

Section IV: Action Taken

< This section should be completed by process owner/work team>
# Corrective Action Responsible Signature Due date

1
2

Section V: Quality Assurance Review

Review of The Relevant Risk Management Report

 Does these actions covered by the risk assessment? Yes No
 Does there any other actions required to be added to the risk? If yes; Yes No
please specify.

Review of Regulatory Compliance

 Does this /these action influence SINCO (Concerned area and or Yes No
products) compliance with the applicable standards, and regulations?
 Does this /these action affect hazards identification and risk Yes No
assessment of this process? If yes; please specify.

Name Job title Signature Date

Section VI: Corrective Actions Implementation Follow-up

Effectiveness
Follow up Follow up Effectiveness
# Follow up result Measurement Signature
Responsible date measure date
result
Ye N Ye N
1
s o s o
Ye N Ye N
2
s o s o

Code: QA-P-05/F01 Issue date 17/10.2019 Rev. 01 Page 2 of 2