Fomat

1. QUALITY ASSURANCE CONCERN QAC No :
Date :
Problem Statement:
Supplier:
Location:
Contact:
Notification via:
Part No:
Part Description:
Quantity send:
Quantity Defective:
Date Received:
Date Rejected :
Where Found:
Disposition: (Check one below)
Return Scrap Sort Rework Other
Action requested : Authorized by:
D1 Team (Name, Location,)
Champion
Team Members
D2 Problem Description:.
D3 Containment Action(s Percent
Effective
Date Implemented
D4 Occur Root Cause:
Verification:
Date Verified
D4 Escape Root Cause(s):
Verification:
Date Verified
D5 & D6 Occur Permanent Corrective Action(s):
Verification:
Validation
Date Verified
Date Implemented
Date Validated
D5 & D6 Escape Permanent Corrective Action(s):
Verification:
Validation:
Date Verified
Date Implemented
Date Validated
D7 Preventative Actions Date Completed
D7 Systemic Recommendations: Responsibility
D8 Team and Individual Recognition Date Closed