PT.
AKURA BINA CITRA
CORRECTIVE AND PREVENTIVE ACTION REQUEST FORM
CPAR No. #015/2018
Date Issued:
November 10, 2018
Affected Department /
Person In Charge
Problem Description
Reference Detail
(Fill where applicable)
Reference Standard /
Procedure
Cause of Problem
Action Needed
Corrective / Preventive
Action
(Use other paper if it is not
sufficient)
Action to prevent
recurrence / occurrence
of problem
(Use other paper if it is not
sufficient)
Proposed by,
Name: Asep Sudrajat
Position: Deputy
Date: December 08, 2018
Management of Change :
Reviewing the
effectiveness of corrective
/ preventive action
Additional Notes
Form No.: 6.4
SPK No. #
Requested Company/ by: Issued to (company or title): Target of Response Time:
QHSE FS December 10, 2018
Field Service
Documented information such as QMM, SOP, WI and Form are available and
updated but there is no single standard book available in place such as for lifting,
and tubular even inspector using their own uncontrolled copy
v Service System Part / Equipment
Internal Audit:
Customer Complaint:
Contract / Work Order No:
Purchase Order No.:
Inspection Report No.:
Part/Equipment No.:
Other:
Document lost due to no awareness of personel
Corrective Action Preventive Action
Completion Date:
Send copy of standard for tubular, lifting and hoisting Evidence Document:
Completion Date:
Any cost due to document lost will be responsible of
Evidence Document:
all affected person, Training & Indoctrination
Reviewed and Approved by, Closing Out Verified by,
Name: Andi Setyo Budianto Name: Andi Setyo Budianto
Position: QHSE Manager Position:QHSE Manager
Date: January 12, 2019 Date:
Yes No Effective Date :
Verified by
Date Verification
Remarks Effective / Not Effective / Repetitive
Rev. No.: 01 Date Issued : 05/01/2015