BK ELECTRONICS PHILS., INC.

CORRECTIVE & PREVENTIVE ACTION REQUEST

Quality Management Department
RECIPIENT (NAME & COMPANY /
DEPT. & SECTION)

CPAR NO.

COMPLAINANT (NAME & SECTION)

FAX NO.

DATE & TIME

LOCATION

TYPE OF NON-CONFORMANCE

PART NUMBER
P.O. NUMBER
LOT NUMBER
LOT QUANTITY

__ Internal Audit
__ External Audit
__ Internal Process

NON-CONFORMANCE
D.R. NUMBER
P.O. QUANTITY
J.O. NUMBER
J.O. QUANTITY

ATTACHED ACTUAL DEFECT OR PICTURE

___ Customer/External Compliants

___ Monitoring & Measurements Limits NC
___ Legal Violations/ISO Standards

MATERIALS
N/A

___ Improvement
Initiative (Preventive)
___ Others ___________

PRODUCTS
TRANSFERRED QTY.
SAMPLING SIZE
DEFECT QTY.
DEFECT %

REFERENCE: A39

STATEMENT OF NON-CONFORMANCE:

________________________
Complaintnant / Date
(Sign. Over Printed Name)

________________________
Recipient / Date
(Sign. Over Printed Name)

________________________
Noted by / Date
(Sign. Over Printed Name)

CONTAINMENT PLAN:
NOTE : Immediate countermeasure while investigating the occurrence or recurrence of the problem.

DATE IMPLEMENTED:
RESPONSIBLE
NAME

SIGNATURE
DATE

BK-L4-QMRF-001-00
Continuation.

DCF # : 045-08

ROOT CAUSE & INVESTIGATION :

MAN
MACHINE
METHOD
MATERIALS
ENVIRONMENT
NOTE : Please specify one by one your investigation regarding the Root Cause of the Problem based on the checked item above.
INVESTIGATING TEAM
Project Leader:
Members:

CORRECTIVE ACTION
(Prevention of the recurrence of the problem):

PREVENTIVE ACTION (Prevention of occurrence of the problem):

CHECKED BY/DATE:
RESPONSIBLE

IMPLEMENTATION DATE

IMPLEMENTATION DATE :
RESPONSIBLE:
CHECKED BY :

COMPLAINANT VERIFICATION
1st Verification
Corrective Action
__ Implemented
__ Effective

2nd Verification
Corrective Action
__ Implemented
__ Effective

Preventive ction
__ Implemented
__ Effective

Preventive Action
__ Implemented
__ Effective

Verified By / Date :
STATUS: 1st Verification :
EXTENTION DATE :
CONFIRMED BY (RECIPIENT) :

BK-L4-QMRF-001-00

EXTENDED

Verified By / Date :
CLOSED
2nd Verification :
EXTENDED
Approved by/Date (1st Verification) :
Approved by/Date (2nd Verification) :

DCF # : 045-08

CLOSED

JINSS LEE PRINTING CORPORATION

CORRECTIVE & PREVENTIVE ACTION REQUEST
Quality Department
RECIPIENT (NAME & COMPANY /
DEPT. & SECTION)

CPAR NO.

COMPLAINANT (NAME & SECTION)

FAX NO.

DATE & TIME

LOCATION
Internal Audit
External Audit

Customer/External Compliants
Monitoring & Measurements Limits NC

TYPE OF NON-CONFORMANCE __ Internal Process

___ Legal Violations/ISO Standards

Improvement
Initiative
(Preventive)
___ Others ___________

NOTE: "For Improvement Initiative (Proventive Action)" Fill-up the following NC Statement, Root Cause Analysis & Preventive
Action slot. Followed by Review (MR) and Approval (GM) prior to implementation

PART NUMBER
P.O. NUMBER
LOT NUMBER
LOT QUANTITY

NON-CONFORMANCE
D.R. NUMBER
P.O. QUANTITY
J.O. NUMBER
J.O. QUANTITY

ATTACHED ACTUAL DEFECT OR PICTURE

MATERIALS
PRODUCTS
TRANSFERRED QTY.
SAMPLING SIZE
DEFECT QTY.
DEFECT %
REFERENCE:

STATEMENT OF NON-CONFORMANCE:

________________________
Complaintnant / Date
(Sign. Over Printed Name)

________________________
Recipient / Review / Date
(Sign. Over Printed Name)

________________________
Approved / Noted by / Date
(Sign. Over Printed Name)

CONTAINMENT PLAN:
NOTE : Immediate countermeasure while investigating the occurrence or recurrence of the
problem.

DATE IMPLEMENTED:
RESPONSIBLE
NAME / SIGN

(sign over printed name)

DATE

JLPC-QAQC-F04-00

Continuation.
ROOT CAUSE & INVESTIGATION :

MAN

MACHINE

METHOD

MATERIALS

ENVIRONMENT

NOTE : Please specify one by one your investigation regarding the Root Cause of the Problem based on the checked item above.

INVESTIGATING TEAM
Project Leader:
Members:

Preventive Action
(Prevention of problem occurrence)

Corrective Action
(Prevention of problem recurrence)

Verifcation Satus

Responsible /
Implementation Date
I

1ST
NI

LEGEND:

____________________________
Checked by (Immediate Spvr.)

Remarks (1st Verification) :

Verified By / Date :
STATUS: 1st Verification :
EXTENTION DATE :
CONFIRMED BY (RECIPIENT) :
JLPC-QAQC-F04-00

____________________________
Accepted by Complainant

I = Implemented
NI = Not Implemented
C = Have Changes

VERIFICATION COMMENTS / SUGGESTION

Remarks (2nd Verification) :

EXTENDED

CLOSED

Verified By / Date :
2nd Verification :
EXTENDED
Approved by/Date (1st Verification) :
Approved by/Date (2nd Verification) :

CLOSED

2ND
C
NI