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FAKIR KNIT WEARS LTD.

MR/3/011
Issue 1

CORRECTIVE AND PREVENTIVE ACTION REQUEST


(Zvr¶wbK Ges `xN©‡gqv`x mgm¨v mgvavb Gi Rb¨ Aby‡iva)
CPA
(wmwcG) #
SECTION A - Reporting Personnel (†mKkb K- Aby‡ivaKvix e¨w³)

Reporting Personnel (Aby‡ivaKvix e¨w³):______________________ Date (ZvwiL):


________
Category of Request (Aby‡iv‡ai aib): System non-conformance (c×ZxMZ mgm¨v)
Process non-conformance (cÖwµqvMZ mgm¨v) Product Non-conformance (cb¨MZ mgm¨v)
Customer complaint (†µZvi Awf‡hvM) Suggestion/Other (gZvgZ)
Problem (mgm¨v)

Signature of Requesting Personnel (Aby‡ivaKvixi ¯^v¶i):

Accepted (MÖnbxq) Rejected (AMÖnbxq) Signature of MR (e¨e¯’vcbv cÖwZwbwai ¯^v¶i)


____________

Assigned for Analysis to (we‡kl‡bi Rb¨ g‡bvwbZ e¨w³): Target Date (wba©vwiZ
ZvwiL): ___________

SECTION B – Analysis (†mKkb L- we‡klb)

Root Causes (gyj Kvib):


______________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Corrective (Immediate) Action (Zvr¶wbK mgvavb):
_________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Preventive Action (`xN©‡gqv`x mgvavb):
____________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Analysis Completed by (we‡kl‡Ki ¯^v¶i): _____________________ Date(ZvwiL) :


______________

SECTION C – Management Representative ( †mKkb M- e¨e¯’vcbv


cÖwZwbwa)

Assigned for Implementation to (mgvav‡bi Rb¨ wba©vwiZ e¨w³): ______ __Target Date (wba©vwiZ
ZvwiL) : ________
FAKIR KNIT WEARS LTD.
MR/3/011
Issue 1

Action completed/Comments (KvR †k‡l gZvgZ):

Confirmed by MR e¨e¯’vcbv cÖwZwbwai ¯^v¶i): _____________________ Date (ZvwiL): _______________

Reporting Person (Aby‡ivaKvix e¨w³): _____________________ Date (ZvwiL):


________________

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