* 1. Supplier Name

* 2. CAR #

* 3. Date Received

Date / Time

* 4. Do you as the supplier, accept responsibility for the problem found?

* 5. If No, please explain

* 6. Containment:
Containment is an analysis of inventory and a purge and correction to eliminate this problem from material in finished goods or work in process. If you have shipped other material to us that you believe contains the same problem, you must notify us immediately.

* 7. Root Cause:
Root cause must get to the real root of the problem. “Operator error” for example isn’t sufficient as we would want to know why they made the error. Neither is “the operator wasn’t properly trained” sufficient, as this requires an explanation of why the operator wasn’t properly trained. Use the 5 Why method if you need to get to the real root cause. See 5 Why Wikipedia link.

* 8. Planned actions to eliminate this problem:
What steps are you taking to eliminate this problem from reoccurring? Also what additional actions will you take to look for similar issues (ie, if one person is poorly trained, who else may need to be retrained.)

* 9. How did you verify effectiveness of your corrective actions?

* 10. When did all actions are completed?

Date / Time

* 11. Your name:

* 12. Date submitted:

Date / Time