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* 1. Date

Date

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* 2. Name of Reporter

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* 3. Short description of the problem, error or audit finding *

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* 4. Affected Area

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* 5. Source of Finding? *

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* 6. Attach supporting documents, e.g. emails, audit findings or documents describing the problem

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* 7. Attach supporting documents, e.g. emails, audit findings or documents describing the problem

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* 8. What type of error, problem, audit finding, or nonconformity occurred? *

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* 9. Potential Root Cause (what caused the error, problem or audit finding) *

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* 10. Type of action taken to correct the error, problem or audit finding *

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* 11. Briefly describe what else needs to be done to correct the error, problem or audit finding, a date for completion, and the responsible person(s) *

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* 12. Attach supporting documentation for corrective action

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* 13. Attach supporting documentation for corrective action

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* 14. Quality Assurance Check

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