CORRECTIVE AND PREVENTIVE ACTION REQUEST

Action Required Request Raised by (Name and Dept.): Date:

Corrective CPA No: (To be filled by MR)
Preventive -
CPA required for (Project / Job / Activity): Responsible Person / Dept: Reference:

Description of Non-conformity:

Analysis of Non-conformity Related to:

Man
Machine
Material
Method
System
Others

CPA Details Respon by (Date)

Comp. On:

By:
Follow-up Remarks:

Action Verified by (Signature): CPA Request Closed on (Date): Signature (MR):

OEL-F-21