CORRECTIVE

ACTION REQUEST

CAR
(Includes Preventive Action)
Rev.04, 25 Sep 2013

NOTE: Receiving Party to complete the 3 boxes below marked 

CAR Number Date CAR issued Response Due Date
[Name1]

Non-Conforming or Safety issue reported by (Print Person responsible for Corrective or Preventive Action
Name)

[Reported By] [Responsible Individual] [Role]

CAR Title (Brief description about CAR) Category, department, function or process area

[CARDescription] QAP - Quality Assurance Procedure

Location of problem, finding

[Location]

Nature and description of the problem, finding

Requirement: [Requirement]

Finding: [Finding]

1 After investigating, what was the Root Cause of this problem or finding?

[Name1] Page 1 of 2
 Date of Investigation: Name & Signature :

2 Corrective Action Plan and Responsibility (What will be done to correct this and who is
responsible for that?):

Date to be complete: Name & Signature :

3 Preventive Action Plan and Responsibility (What can be done to prevent this in the future
and who is responsible for that?):

Date to be complete: Name & Signature :

Verified by
Signature Name & Designation

Reviewed and Accepted by the Originator

Signature Name & Designation

Programme Management Consultant Quality Date Closed

Manager’s initial after the CAR response is
accepted and confirmed closed Signature

Notes can be made on back of this form if additional space is needed.

[Name1] Page 2 of 2