Supplier Corrective Action Request Form

General Information

Supplier Name & ID Number

Supplier Representative Name & Email Address

Part Name & Number

Quantity Rejected

Description of the Problem

Investigation for Root Cause

Did you go to the place where the work is performed and review the process (gemba)

?Did you review work instructions and procedures

?Did you talk to employees involved with this process

?Is the requirement adequately defined and documented

Have any changes been implemented around the time of this defect for process(es) related to this defect

Is tooling & fixtures, process sequencing, and storage/handling of material complete

What is the root cause for the technical problem that caused the nonconformity

How did the non-conformance escape the process? Why did the quality system fail to detect the non-conformance

How did the product development/production/support processes contribute to the problem

Has the root cause identified a fundamental breakdown or failure of a process

Has the element of the process that caused the root cause been corrected

Activity Type

Detailed Description of Corrective Action

Name & Title of Person Responsible

Expected Completion Date

Objective Evidence after Completion

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