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  • Corrective and Preventive Action Request Form

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    f09ai
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    This document outlines a corrective and preventive action request form. The form has two parts: origination and assignment/proposed action. Part 1 collects information about the request originator, type of action, source, date, process involved, and description of the problem with objective evidence cited. Part 2 is for assigning responsibility for the request, determining the root cause, investigative actions to take, due dates, actions taken, verification of actions, assessment of effectiveness, and approval of actions.

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    ems form

    Original Title

    Ems Cpar Form

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    This document outlines a corrective and preventive action request form. The form has two parts: origination and assignment/proposed action. Part 1 collects information about the request originator, type of action, source, date, process involved, and description of the problem with objective evidence cited. Part 2 is for assigning responsibility for the request, determining the root cause, investigative actions to take, due dates, actions taken, verification of actions, assessment of effectiveness, and approval of actions.

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    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
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    196 views3 pages

    Corrective and Preventive Action Request Form

    Uploaded by

    f09ai
    This document outlines a corrective and preventive action request form. The form has two parts: origination and assignment/proposed action. Part 1 collects information about the request originator, type of action, source, date, process involved, and description of the problem with objective evidence cited. Part 2 is for assigning responsibility for the request, determining the root cause, investigative actions to take, due dates, actions taken, verification of actions, assessment of effectiveness, and approval of actions.

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    © All Rights Reserved
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    of 3

    Corrective and Preventive Action

    U.S. Department of Commerce


    Request (CPAR) R1 DRAFT 9/27/10
    CPAR #
    PART 1 - ORIGINATION
    1. Originator
    Name Organization Phone E-Mail

    2. Type
    Corrective Action Preventive Action
    (Actual Nonconformance) (Potential Nonconformance)
    3. Source
    Audit - Internal Customer Complaint / Feedback

    Audit External Product / Service Problem

    4. Date of CPAR Request / / 5. Audit Number, if applicable


    6. Process / Procedure, if known
    Document Title / Number Reference Paragraph
    ISO 14001:2004, Para. _______

    7. Description of Problem (Cite Objective Evidence)

    EMS CPAR-FORM Rev 2 Page 1 of 3


    Effective Date: 3/20/06
    EMS CPAR-FORM Rev 2 Page 2 of 3
    Effective Date: 3/20/06
    PART 2 - ASSIGNMENT & PROPOSED ACTION
    8. Assigned to
    Name Organization Phone E-Mail

    9. Root Cause of Problem

    10. Investigative Action To Take

    11. Due Date


    _ /__/__
    12. Action Taken

    13. Action Verification

    14. Effectiveness of Action Taken

    15. Action Approval


    ____/____/____

    EMS CPAR-FORM Rev 2 Page 3 of 3


    Effective Date: 3/20/06

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