PT.

BATTERY POWER SOLUTIONS INTERNATIONAL

CORRECTIVE-PREVENTIVE ACTION REQUEST/

FORMULIR PERMOHONAN TINDAKAN PERBAIKAN Ref. No. CPAR-
& PENCEGAHAN
PART A
CAR - Corrective Action Request; PAR - Preventive Action Request; OP-5.6-01 - Management Review; OP-8.2-02 - Internal Quality
Audit; OP-4.2-01/02 – Documentation Requirements; DEFECT - Result of a Product NC; Repetitive NCR; CUSTOMER - Customer
Complaint; OTHER - specify the nature of the CPAR

OP-4.2- REPETITIVE
CAR PAR OP-5.6-01 OP-8.2-02 DEFECT CUSTOMER OTHER
01/02 NCR

Issued By Department Date Issued Issued To Department

Item WHAT IS THE IDENTIFICATION PROBLEMS, SUGGESTIONS/

No. APA YANG MENJADI IDENTIFIKASI PERMASALAHAN, SARAN

I AGREE TO REPLY THE REQUEST WITHIN ___ WEEK/S OF ISSUE/ SIGNATURE

SAYA SETUJU UNTUK MEMENUHINYA DALAM WAKTU ___ WEEK/S OF ISSUE/ DATE

PART B

Item
RESULT OF INVESTIGATION / ROOT CAUSE OF NON CONFORMANCE/
No.
HASIL INVESTIGASI/AKAR MASALAH KETIDAKSESUAIAN

PART C

Item CORRECTIONS TAKEN TO CORRECT THE PROBLEM/ PREVENTIVE ACTIONS

No. KOREKSI YANG DIAMBIL UNTUK MEMPERBAIKI ELIMINATE THE CAUSES OF
PERMASALAHAN POTENTIAL NC/
TINDAKAN PENCEGAHAN MENGURANGI
POTENSI PENYEBAB KETIDAKSESUAIAN
PIC : PIC :

TARGET TARGET
DATE: DATE:

Item CORRECTIVE ACTIONS ELIMINATE THE CAUSE OF NC TO LIST OF SUPPORTING

FM-CPA-001, Rev.02, P1/1

 PT. BATTERY POWER SOLUTIONS INTERNATIONAL

No. PREVENT RECURRENCE / TINDAKAN PERBAIKAN UNTUK DOCUMENTS / DAFTAR

MENGELIMINASI PENYEBAB TERULANGNYA DOKUMEN PENDUKUNG
KETIDAKSESUAIAN
PIC :

TARGET
DATE:

THE CORRECTIVE OR PREVENTIVE ACTION TAKEN MEET MY SIGNATURE &

REQUIREMENTS / TINDAKAN PERBAIKAN ATAU PENCEGAHAN DATE /
MEMENUHI PERSYARATAN TTD & TGL
PIC: Person in Charge

PART D

APPROVED BY SIGNATURE DATE

QA/QC Manager

QA/QC MANAGER’S
COMMENTS:

FM-CPA-001, Rev.02, P1/1