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Company Name
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Quality Assurance Department
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Form No.
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Issue Date:
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Revision No:
Report No #
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Product Name
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Batch No
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Batch Size
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Mfg Date
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Expiry
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Packing
Date
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Ref .NCR No
____________ Date _______________
Description of
complaint:
_________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________
Route cause
Analysis: (Please attach complete investigation report if required)
_________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Immediate action
taken:
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
CAPA:
Corrective action taken:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Preventive actions recommended:
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Investigated by:
Remarks by Quality Assurance manager (if any): ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
QA manager: Date:
Remarks by Director (if any): ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Director: Date: