DD LOGO TYPE: RETAIN FOR: FOR USE SEE: ISSUE: REF:

Form
COMPLAINT No:
ITLE: QUALITY PROBLEM REPORT
ART No: DATE: CUSTOMER:

RODUCT: QTY REC: QTY REJ:

o.M: SAMPLES: BATCH: DEFECT%:

W/S No.)
NTERNAL/EXTERNAL MEMBERS: Customer Complaint Samples requested
SSEMBLY ………………… RAISED BY:……………………
RODUCTION ………………… INSPECTED BY:……………….
Final Audit Reason requested
UALITY ………………… In-process Batch size requested
UPPLIER ………………… DISCIPLINE 1

ROBLEM DESCRIPTION: REOCCURRENCE? Y N Passed To:

ISCIPLINE 2 (Quality) Date……………

ONTAINMENT PLAN: Action By:
e g Stop production, Check & Sort stock, Quarantine stock. 100% inspection required.)

ISCIPLINE 3 Date……………
ESCRIBE ROOT CAUSE:
e g Material, Machine, Methods, Manpower, Maintenance.)

ISCIPLINE 4
ERMANENT CORRECTIVE ACTION PLAN: Action By:
g Totally eliminates the root cause.)

ISCIPLINE 5 Date……………..
REVENT REOCCURRENCE: Action By:
e g Describe what we have changed to guarantee action above.)

ISCIPLINE 6 Date……………….
ERIFICATION OF EFFECTIVENESS: Completed by:
g Check jigs, Review Modifications, and Check work is complete.) (Quality Signature)

ISCIPLINE 7 (Quality) Date ……………..

verification unsuccessful further action required by: Action by & date:

MENDED BY: APPROVED: DATE: PAGE: