Documented Customer Complaint DCC#YYMMNNNr

Generated By Customer Time of Contact*

Customer Contact: Phone No.* FAX No.* Date of Contact

Part Affected: (Number / Name) * Process Affected: * Operation Affected: (Number / Name)*

Date Customer Received Product * Description of Problem or Complaint:

Packing Slip No. * QTY *

Job No.* PO No.*

Product
Return System, Process,
Type of Complaint Nonconfor
Material Authorization and/or Support
mance
Analysis Requested? Samples Received? Number of Samples?

(Your Company) Analysis Results

Product
Nonconfor
mance
Performed By:
& Containment
AffectedQuantity

Product Affected (e.g. Shipped, Stock: Disposition Status

Actions Stock, WIP, Supplier)?
WIP:
Supplier:
Shipped:

Assigned RMA No. Quantity Returned Date Returned Purchase Order No.

WTS Disposition / Instructions Rework at Customer

Return Scrapped at Customer

Material Rework at (Your Company)
Authorization
Authorized By: Scrapped at (Your Company)

Replacement Required (QTY) Date Replacement Due Replacement against PO

Requires CPAR Yes If CPAR is not Required, then what Action Assigned To
Invest Function/Department is Primarily
igatio No Responsible?
n?
Action Taken
System,
Process, and/or
Support
---------------------------
Corrective Action

Reported By:
Instruction: *…Initiator to Complete the Header Information as it Applies to the Customer Complaint.
If it is a product complaint, then request samples be marked and sent with the Packaging Label to the
ATTENTION of: V.P. Quality

FQC021.02 (04/19/00)
 Documented Customer Complaint DCC#YYMMNNNr
Your Company
Address

FQC021.02 (04/19/00)