CORRECTIVE ACTION REQUEST (CAR) CAR No.

Project Name
Applicable
‡ Internal ‡ External
Report No.
Responsible

Issued Date
Organization

Required
Related Document
Reply Date

Requirement of Corrective Action Attachment : ‡ Yes ‡ No

Prepared by : ______________ ________ Approved by : _______________ ________

Date QA/QC Manager Date

Cause of Variation/ Action being taken to prevent recurrence and schedule

Attachment : ‡ Yes ‡ No

Prepared by : _____________ ________ Approved by : _______________ ________

Date Date

Response Review Verification of Corrective Action

‡ Satisfactory ‡ Unsatisfactory ‡ Satisfactory ‡ Unsatisfactory

Reviewed by : _______________ ______ Verified by : _____________ ______

Date Date

Approved by : ______________ ______ Approved by : ______________ ______

QA/QC Manager Date QA/QC Manager Date