Shafisons Engineering (Pvt.) Ltd.

Corrective Action Request (CAR) Form

Document Code: SSEPL/FRM-014 Rev#: 01 Issue Date: 22-Mar-2018

CAR No (to be filled): 285

CAR Initiated on (Date): 21-Jul-18 CAR Initiated by (Name): Tahir Iqbal

CAR Initiated due to (Please tick relevant appropriate box below):

Non-Conformance Complaint Air Emission Spillage

Internal / External Audit Suggestion Incident/Hazard Effluents

A. Description (to be filled by Initiator):

One of our client Atiq & Sons (Usman) visit in our head office and met customer services representative and raise compalint of
wrong delievery aginst SO# 125 and DC# 135. According to the client, they receive 12 SWV Plain Bend 45 degree instead of 90
degree. The client leave 12 Plain Bend 45 degree in head office for replacement.

Signature

Accepted / Rejected: Marked to: Date:

If accepted then Factory/HR Manager to mark it to concerned dept. for Analysis:

B. Root Cause Analysis:

C. Proposed Corrective Action:

Name & Signatures

(Person who carried out Root Cause Analysis and Proposed Corrective Action)

D. Verification by the Factory/HR Manager for Implementation & Effectiveness:

Is Proposed Action Implemented: YES / NO Is it Effective: YES / NO

Comments (if any):

CAR closing date: Sign: