FORM OF CUSTOMER COMPLAINT REPORT

Accepted By : Date/Month/Year :
Name : Division/Position:
Company : Telephone :
Fax :
Complaint :

Solved by Myself
Solved by Relevant Division
Temporary Action:

Cause/Analysis:

Corrective Action:

Planning Date : _____________ Finish By : ______________

Finish Date : _____________ Signature : ______________
Verification Status : OK / NG

Description :

Verification By : ________________

Signature : ________________

Correction by, Accepted By,

PSLI-SLS-FR-001 Page 1 of 1 Rev.00/25.03.2022