Continuous Improvement Form

Date:
Name:
Department:
1. Please describe the opportunity for improvement .
(Include specific details of the problem, how it was identified, and how it can be improved)

2. Please describe the benefits of the improvement and/or what can happen if not improved.
Health &Safety Operations Engineering Process Environment Other:

The below information is to be filled out by the management team

Approved [] Rejected []

Rate the priority of this improvement.

Low priority Medium priority High priority

CI # : Champion:

Team Members:

(Are other processes affected, is documentation affected, etc.)

Risk Analysis:

Action Plan:

Start date: Target End Date: Actual End Date:

Verification of improvements

Results:

Verified By: Date:

Verified By: Date:
Closed By: Date:

QLY-FRM-056.1 6/6/2024 UNCONTROLLED WHEN PRINTED