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List Your Processes Here: Enter Full Name of CAR Form Here Enter Abbreviated Name of Your CAR Form Here

This document is a template for a Corrective Action Request (CAR) form. It includes fields to identify the process, type of action, source, priority, and description of the issue. Assignees are responsible for documenting containment actions, root cause analysis, and an action plan. Upon completion, the effectiveness of the actions is verified by another party and the result is indicated. The form also includes fields for things like the name of the requestor and date. The overall purpose is to document and track issues found and their resolution.

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Selvaraj Simiyon
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© © All Rights Reserved
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Download as XLSX, PDF, TXT or read online on Scribd
78 views

List Your Processes Here: Enter Full Name of CAR Form Here Enter Abbreviated Name of Your CAR Form Here

This document is a template for a Corrective Action Request (CAR) form. It includes fields to identify the process, type of action, source, priority, and description of the issue. Assignees are responsible for documenting containment actions, root cause analysis, and an action plan. Upon completion, the effectiveness of the actions is verified by another party and the result is indicated. The form also includes fields for things like the name of the requestor and date. The overall purpose is to document and track issues found and their resolution.

Uploaded by

Selvaraj Simiyon
Copyright
© © All Rights Reserved
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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List your Enter full name of

processes here: CAR form here


Process 1
Process 2 Enter abbreviated
Process 3
Process 4
name of your CAR
Process 5 form here
Process 6
Process 7
Process 8
Process 9
Process 10 Enter name or title of
CAR Administrator
here
For example, "Corrective Action Request"

For example, "CAR"

For example, "John Smith"


#
() - Rev 0
00
00
Type Corrective Action (existing issue) Preventive Action (potential issue) Name:
Check one
Opportunity for Improvement / Suggestion Date:

Customer
Employee Feedback ✘ Supplier / Subcontractor Feedback
Feedback
Source External Audit Internal Audit
Check one
✘ Management Review Action Item
Finding Finding
Other:

Process 1 Process 2 Process 3


Process 4 Process 5 Process 6
Process
Check one Process 7 Process 8 Process 9
Process 10 Other:

Priority
Check One Low Medium High Urgent / Critical
Describe the issue or problem in detail.

Stop here. Submit to

Assigned to: Date Assigned: Respond by:


To be completed by the Assignee.
Containment / Immediate Corrections: (Required only for corrective action requests.)

Root Cause of Problem: (Required for all corrective and preventive issues; optional for suggestions for improvement.)

Action Plan: (Actions taken to eliminate root cause, resolve issue and prevent recurrence.)

Date Action Completed: Name:


Stop here. Return to

Effectiveness verified by: Date:


Result: PASS FAIL: Returned for Further Processing

Notes and
justification:

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