CORRECTIVE ACTION REQUEST

No. :
:

Part No : Part Name : Problem Location :

Samples Yes [ ] No [ ] Attachment Yes [ ] No [ ]

Discrepancy :
/
Orginator : Approved By : Date :

Please answer on or before

Cause :

Corrective Action :

Preventive Action:

Implement Date :

Action By : Approved By : Date :

Follow up result :
Open
Closed
Checked By : Approved By : Date :

ATFM-FSC-009A
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