CAR- _____ - ______

NORTHERN MINDANAO MEDICAL CENTER

CORRECTIVE ACTION REQUEST

Section 1. NONCONFORMITY DEFINITION

Source: Customer Complaint Internal Quality Audit Unmet Target System Incident
Date of Issuance of CAR: Departmental Process Seen:
What happened:(Clear nonconformity definition)

When did it happen:(Period, Date of Audit or Actual Date of Incident) Where did it happen:(Division/Section)

Objective Evidence:(Proof or evidences that the nonconformity exists. E.g. Documents, records, statement of facts and observations)

Requirement Not Fulfilled:(What should be? E.g. ISO 9001:2008 Clause No., Office Policies, Statutory & Regulatory Requirement, Service
Requirement, QMS Documents Established – Quality Manual, Procedures and Work Instructions)

Issued By:(Any employee, Supervisors or Auditors) Date Issued:

Section 2. ACTION PLAN (Attach separate sheet if necessary)

2.1 Correction: Immediate action to correct the nonconformity with completion dates: Reviewed By:

Date:
Approved By:

Process Owner: Signature: Date:

 2.2 Root Cause Analysis (Attach separate sheet as necessary).

2.3 Corrective Actions: To address the cause of the NC with Completion dates and person/s responsible for each corrective action.
Root Cause Corrective Action Persons Responsible Completion Dates

Prepared by Reviewed by Approved by

Date: Date: Date:

Section 3. FOLLOW-UP ACTIONS (Attach separate sheet if necessary)

3.1 Follow-up on correction taken: (Was the nonconformity properly corrected?) Verified By:
Yes Details:
No

Date:
3.2 Follow-up on corrective action: (Was the corrective action implemented?) Verified By:
Yes Details:
No

Date:
3.3 Effectiveness of Corrective Action: (Did it prevent the nonconformity from recurring? Verified By:
Yes Details:
No

Date:
Close Out By: Date:
F-IQA-012/REV.2/21NOV16