COMPLIANT. NO.
Logo CORRECTIVE & PREVENTIVE ACTION REPORT(CAPA)
DATE
Raised by Received by Mode of Receipt:
Location/Process/Reference Guidence doc ref.
Occurrence First Time Second time Repeated
Details of Compliant: (Attach samples or Photos if available)
Raised by & Date: Process Head Approval & Date:
Analysis Team Details:
Correction /Immediate action taken
Target Date for Action: Responsibility: Status:
Root Cause(s) :
Why 1:
Ans:
Why 2:
Ans:
Why 3:
Ans:
Why 4:
Ans:
Why 5:
Ans:
Corrective Action:
Responsibility Target Date
Preventive Action :
Responsibility Target Date
CAPA Verification & Effectiveness CAPA STATUS
Closed
Name & Sign Date: Not Closed
Doc No: Rev :00; Date: