CORRECTIVE ACTION REPORT

REPORT NUMBER: DATE:

PART NUMBER: SHOP ORDER NUMBER:

ORIGINATED BY: QUANTITY AFFECTED:

DUE DATE: RESPONSIBLE MANAGER/TEAM LEADER:

DESCRIPTION OF NONCONFORMANCE

ROOT CAUSE:

CORRECTIVE ACTION: IMPLEMENTATION DATE:

PREVENTATIVE ACTION:

EMPLOYEE’S SIGNATURE AND DATE:

MANAGER/TEAM LEADER’S SIGNATURE AND DATE:

FOLLOW-UP DATE: VERIFIED CORRECTIVE ACTION: YES NO

CLOSEOUT: COMPLETED RESCHEDULED NEW IMPLEMENTATION DATE:

SIGNATURE AND DATE OF PERSON CLOSING OUT:

REVISION: 03/27/06 FORM: 8.5.01

CORRECTIVE ACTION REPORT

REVISION: 03/27/06 FORM: 8.5.01