Page 1 of 2

KIRLOSKAR TECHONOLIGIES (P) LTD

(Quality assessment services)
Document: Quality Record Format Document No.: KTPL/ 8.5QF-01-00
Clause 8.5 Title: Deviation and CAPA Record
Issue No.: 01 Issue Date: Rev No.: 00 Rev Date:

Risk Assessment No. of which CAPA to be taken: Date:

Deviation Observed:

Impact assessment of the deviation:

CAPA:

Prepared by: Approved by:

Sign & Date: Sign & Date:
Name: Name:
Designation: Designation:
 Page 2 of 2
KIRLOSKAR TECHONOLIGIES (P) LTD
(Quality assessment services)
Document: Quality Record Format Document No.: KTPL/ 8.5QF-01-00
Clause 8.5 Title: Deviation and CAPA Record
Issue No.: 01 Issue Date: Rev No.: 00 Rev Date:

Note: For proper clarification extra sheet can be attached.

Compiled By Approved By
(Sign/Date) (Sign/Date)

Prepared by: Approved by:

Sign & Date: Sign & Date:
Name: Name:
Designation: Designation: