Section 1: Report Information Your Name
Company Name
Your EmailA copy of this form will be sent to this email.
Section 2: Schedule and Audit Type
Date Schedule Submitted
Date Schedule Due
Specific Audit Type QP-1QP-2QP-3QP-4QP-5QP-6QP-7QP-8QP-9QS-1QN-1
Section 3: Describe the Deficiency
Audit Deficiency Number
Description of Deficiency
Action to Fix Problem
Section 4: Root Cause Analysis
Why did the deficiency happen? Include a detailed explanation of where the lapse in procedure occurred or if the procedure existed.
Who was the person responsible for overseeing and where was the breakdown that allowed the deficiency to occur?
Section 5: Corrective Action
How is the deficiency being rectified?
Who is responsible for implementation and oversight?
What steps have been taken to ensure this deficiency does not happen in the future?
Please List the specific procedures to be revised
Section 6: Contractor Contact Information
Name Title Email Additional Comments
Section 7: Submitted Cap Action Items
Identify additional personnel required for implementation
Implementation Date
Is additional Training Required?YesNo
Details
Is Equipment Required?YesNo
Document Revision Required?YesNo
Impact on Schedule or Work Plan?YesNo
Is Customer Approval Required?YesNo
Identify The Person Responsible for Authorizing Action
Section 8: Upload Supporting Documents *Max File Size 5 MB