Corrective Action Report MPM CAR Cust Complaint

corrective action report mpm c.a.r. # cust. complaint # (if space is limited use an additional sheet of paper and staple it to

Corrective Action Report
MPM C.A.R. #
Cust. Complaint #
(If Space Is Limited Use An Additional Sheet Of Paper And Staple It To
This Corrective Action)
1
Type: Customer  Supplier  Internal 
Customer/Supplier:
Part/Mat'l #:
External Contact Name
Quantity:
External Contact Phone:
Initiated By:
Forward To: (for step 2)
Initiation Date:
Due Date: Pending Due Date:
Respond To Customer? Yes  No By Date: Plant Visit Required? Yes  No

Describe The Problem:
Can the problem affect other products or processes?
Is it a systemic problem that can re-occur?
Responses are required by Team Champion! See Steering Committee for
actiom
2
Team Champion:
(Team Roster & Tracking Sheet Required)
Position/Group &
Phone:
3
What Did You Do To Contain The Problem?
(Purge System As Warranted)
If the problem affects other product/process or is systemic, how were
they contained?
4
Root Cause (s):
Ask Why 5 Times. Personnel Failure Not Acceptable!
5
What Actions Corrected The Root Cause?
List actual actions taken, not actions that will be taken in the
future! If additional time is required see Q.A. to place C/A in
pending status.
6
List Data That Verifies Corrective Action:
Evidence Required
Was FMEA Revise? Yes  No 
(required only when C/A is for product or process)
7
Department Manager: Accept  Reject  Signature: Date:
Quality Assurance Supervisor/Analyst: Accept  Reject  Signature:
Date:
Quality AssuranceManager: Accept  Reject  Signature: Date:
8
Congratulate Team!
Note: Quality Assurance Manager returns C/A to Q.A. Analyst for
re-issue or close C/A.
qs-141A 1/19/99