SEC A-        TO BE FILLED BY THE REPORTING PERSON

Date

 

Time

 

Product Name

 

Batch No

 

CAPA No

 

Department

 

Stage/Process

 

Reporting Personnel

 

Designation

 

Deviation/Non Conformance (Brief Description)

 

 

 

Root Cause Analysis /Investigation

 

 

 

Corrective Action

Responsibility

Target Date of Completion

Actual Date

of Completion

 

 

 

 

 

Preventive Action

Responsibility

Target Date of Completion

Actual Date

of Completion

 

 

 

 

 

Document Change

Responsibility

Target Date of Completion

Actual Date

of Completion

 

 

 

 

SEC B-        TO BE FILLED BY QUALITY ASSURANCE DEPARTMENT

Corrective & Preventive Action Review

Corrective Action

Taken

 

Not Taken

 

Effective

 

Not Effective

 

Preventive Action

Taken

 

Not Taken

 

Effective

 

Not Effective

 

QA Officer

QA Manager