Corrective Action Request - Magnetek

Corrective Action Request
This form is used to request and track corrective action for a part, process, or documentation problem.
Requested By:
Part #:
Order # / P.O. #
Request Date:
Part Description:
Customer / Supplier:
Serial # : Fault / AR # :
Misc. Info.:
Project Name:
Team: (Members involved in the analysis and resolution of the problem.)
Problem Description: (Supply all available relevant information and quantify the problem. If possible,
investigate the cause of the problem and recommend any short or long term corrective action.)
Interim Containment Action: Assigned to: Due by:
(Record what was done to immediately stop or fix the problem. Recommend any long­term suggestions.)
Taken by : Date: Forward form to Quality Assurance
Root Cause Investigation: Assigned to: Due by:
(Conduct an investigation to determine the underlying cause of the problem and report the findings.)
Reported by: Date: Forward form to Quality Assurance
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Short Term Corrective Action: Assigned to: Due by:
(Describe what steps were or will be taken to prevent recurrence of the problem pending the implementation
of Long Term Corrective Action.)
Initiated by : Date: Forward form to Quality Assurance
Long Term Corrective Action: Assigned to: Due by:
(Describe what steps were or will be taken to permanently fix the problem, and steps to prevent this and other
similar potential problems.)
Initiated by: Date: Forward form to Quality Assurance
Verification of results : Assigned to: Due by:
(Describe what measures or checks were performed to demonstrate that the actions were effective.)
Checked by: Date: Forward form to Quality Assurance
Next section to be completed by Magnetek PCS (when Fault Log is not Used)
Correction confirmed by:
Follow­up required: Ž Yes Ž No
Date:
If yes, provide date:
Magnetek PCS: Title: Date:
Distribution: Pending and completed forms are filed in the Purchasing Department. Copies are distributed to other departments as needed.
Closed and filed, or Reissued
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