Corrective Action

Corrective and Preventative Actions Incident No.:

List the root causes identified from the Causal Factors & Root Causes Worksheet below. Indicate the immediate corrective action to
be taken to correct the root cause. Review each root cause to determine if there are long term preventative actions that need to be
implemented.

Root Cause(s) Corrective Action Preventive Action Due Assigned Completion Cost/pic/legal
Date To Date
1.

2.

3.

4.

5.