Corrective and Preventative Actions Template

Template Version 3.04 October 2010

Title and Acronym (if available)

Sponsor:
CTA ref:
R&D number:
EudraCT number:
REC ref:
Principal Investigator:

Summary:
How the issue/breach was identified and short summary (3-4 lines)

Finding:

Corrective Actions:

Preventative Actions:

Acknowledged by:

Sponsor/
Host Organisation

………………………….. …………………………………. …………………………….. …………………

Name Position Signature Date

Name of Support
Department (if relevant)

………………………….. …………………………………. …………………………….. …………………

Name Position Signature Date

Principal Investigator

………………………….. …………………………………. …………………………….. …………………

Name Position Signature Date

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