DEPARTMENT: DATE:

DEPARTMENT INCHARGE:

PROBLEM/NON-CONFORMITY FOUND:

ROOT CAUSE:

CORRECTIVE/PREVENTIVE ACTION PROPOSED:

TARGET DATE: RESPONSIBILITY:

CORRECTIVE ACTION CHECK STATUS

STATUS COMPLAINT REPEATED
CORRECTIVE/PREVENTIVE ACTION TAKEN:
After 1 month
After 2 month
CORRECTIVE/PREVENTIVE ACTION: ACCEPTED NOT ACCEPTED After 3 month
After 4 month
ACTION TAKEN VERIFICATION: REMARKS OF AUDITOR:

CORRECTIVE/PREVENTIVE ACTION FORM

Form No. JMCH/ASET/CAPA/01/00