Supplier Corrective Action Request Form

Updated: over a week ago

Supplier Corrective Action - Request Form

General Information

1. Supplier Name & ID Number


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2. Supplier Representative Name & Email Address


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3. Part Name & Number


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4. Quantity Rejected


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5. Description of the Problem


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6. Investigation for Root Cause


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7. Did you go to the place where the work is performed and review the process (gemba)?


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8. Did you review work instructions and procedures?


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9. Did you talk to employees involved with this process?


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10. Is the requirement adequately defined and documented?


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11. Have any changes been implemented around the time of this defect for process(es) related to this defect?


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12. Is tooling & fixtures, process sequencing, and storage/handling of material complete?


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Direct Cause

1. What is the root cause for the technical problem that caused the nonconformity?


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Detection Cause

1. How did the non-conformance escape the process? Why did the quality system fail to detect the non-conformance?


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Systemic Cause

1. How did the product development/production/support processes contribute to the problem?


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2. Has the root cause identified a fundamental breakdown or failure of a process?


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3. Has the element of the process that caused the root cause been corrected?


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Permanent Corrective Actions & Recurrence Prevention

1. Activity Type


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2. Detailed Description of Corrective Action


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3. Name & Title of Person Responsible


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4. Expected Completion Date


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5. Objective Evidence after Completion




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Checklist by GoAudits.com – Please note that this checklist is intended as an example. We do not guarantee compliance with the laws applicable to your territory or industry. You should seek professional advice to determine how this checklist should be adapted to your workplace or jurisdiction.

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