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HMA Corporation

1234, Whereroad, Whereplace, Neverland

CORRECTIVE ACTION REQUEST (CAR)


Doc No: __________
Rev 0, Issue 1

CAR Control No. Type of Non-conforminty (please mark):


Date Product
Initiated by Process
Section/ Department Audit (internal)
Record path Audit (customer)

Return to initiator on: Audit (third party)

I. Description of Deficiency: Minor Major Serious


Non-conformance Statement (Overview of the finding and evidences seen):

Violated Quality and Food Safety Standard(s): Legal, Customer, ISO, BRC, IFS, etc.

Corrections for the obvious cause (Immediacte actions to regain control and containment to eliminate the detected non-conformity). Root
cause not needed.

Corrections/ Containment plan Responsible Time Frame

Root Cause Analysis (to be accomplished by the auditee): Method:


Element Root Cause(s) Prioritization

Man
Method
Machine
Material
Environment
Time
Others
If applicable: Potential Effect of Deficiency (Other problems that may happen as a result of the existing NC)

Auditee: Auditor:
II. Action Required to correct the problem and/ or prevent its recurrence (to be completed by auditee or process owner):
Implementation
Countermeasures (CM)/ Corrective Action Responsible
Date

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Date Completed: Auditee: Auditor:
III. Follow-up required to confirm that action has been taken and is effective:
Monitoring of effectiveness
Months of Quantifiable Improvement
Monitoring recurrences Rate
Remarks (Is the desired improvement and effectiveness indicator achived?)

Date finalized : Signed (Auditor):


Signed (Auditor):
CAR Closed on:_________________________ Management Review/ Verification (Remarks, if
(can only be closed if the applicable):
desired effectiveness level is achieved. If effectiveness level is not achieved, revisit and enhance
the root-cause and corrective actions. Summarize the enhancements made below.):

Corrective Action Enhancements (date: ____________)

(Applicable only if the result of the review revealed that the effectiveness level is not achieved)
Element Root Cause(s) Prioritization

Man
Method
Machine
Material
Environment
Time
Others
Implementation
Countermeasures (CM)/ Corrective Action Responsible
Date

Signed (Auditor):
CAR Closed on:_________________________ Management Review/ Verification (Remarks, if
(can only be closed if the applicable):
desired effectiveness level is achieved. If effectiveness level is not achieved, revisit and enhance
the root-cause and corrective actions. Summarize the enhancements made below.):

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ease mark):
Legal
Customer
KPI
Design (R&D)
Others
Critical

ed non-conformity). Root

Implementation
verification

Approved by
Management?

f the existing NC)

cess owner):
Effectiveness
Indicator

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ndicator achived?)

Verification (Remarks, if

eved)
Approved by
Management?

Effectiveness
Indicator

Verification (Remarks, if

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