AFRICA Q-HSE DEPARTMENT

Improvement Action Form

QUA-F-0028 Rev 03

Branch: Form Number: Activity:

Identification

Concerned process: Date: Action Type: Origin:

Finding:

Please estimate / Describe the benefits resulting of the resolution of the deficiency (claim, time, avoided mistakes, etc…): In case of a non-conformity, describe the immediate actions taken:

Person in charge: Realization date: Signature of Q-HSE Coordinator:

Cause analysis
Tick the concerned item(s): Cause analysis Proposed actions
Methods N° Proposed solutions Person in charge Deadline

Manpower - Training

Mother Nature - Environment

Machines - Equipment
Materials - Products
Management
Others

Validation
Checker's name: Date and Signature: Efficiency Acceptability criterias
Yes No
Action N°: