Form 109, Corrective-Preventive Action Log

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Form 109: Corrective/Preventive Action Log (Action Request Log)


AR No.

Initiator

Date
Initiated

Form 109, Rev. 0, 12th Nov, 2012

Description of Problem (Nonconformance / Potential


Nonconformance)

Page 1 of 1

Root Cause

Action Taken

Date
Closed/Result

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