CORRECTIVE/PREVENTIVE ACTION REQUEST (sample)



|CORRECTIVE/PREVENTIVE ACTION REQUEST |CPAR No. | |

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| |Corrective Action | |Preventive Action | |Opportunity for Improvement |

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| |Source |Reference |Comments |

| |Internal Audit | | |

| |External Audit | | |

| |Customer Complaint | | |

| |Product Deficiency | | |

| |Previous CPAR | | |

| |Other: | | |

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|Description of Nonconformance, Risk or Opportunity for Improvement: |

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|Initiator: | |Signature: |Date: | |

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|Received and Entered into CPAR System by: |Signature: |Date: | |

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|Assigned to: |Reply Due Date: | |

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|Root Cause: |

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|Actions Taken or Planned: |

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| |Planned Completion Date: | |

|Submitted by: | |Signature: |Date: | |

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|Comments by Approval Authority: |

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|Approved by: | |Signature: |Date: | |

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|Followed Up by: | |Signature: |Date: | |

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|Effective? | |Yes | |No |Evidence: |

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|Closed Out by: | |Signature: |Date: | |

|Alloys International Form 8.5.1 Rev 01-04-06 |

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