HFORM05: Corrective Action Form¶
Form Reference: HFORM05 Version: 1.0 Classification: CRGI Information Form Owner: Sean Ashton, Operations Manager Purpose: Corrective Action Request (CAR) lifecycle management per HPROC14. Tracks non-conformities from identification through root cause analysis, correction, corrective action, implementation and effectiveness review.
Document Control¶
| Version | Date | Author | Change Summary |
|---|---|---|---|
| 1.0 | 10/03/2026 | Sean Ashton | Initial issue |
1. CAR Details¶
| Field | Details |
|---|---|
| CAR Reference | CAR-YYYY-___ |
| Date Raised | _________________ |
| Priority Level | ☐ Critical (stop work, immediate action) ☐ High (within 1 week) ☐ Medium (within 2 weeks) ☐ Low (within 4 weeks) |
Source of Non-Conformity (select one)¶
☐ Internal Audit finding
☐ External Audit finding (client, ISO, regulator)
☐ Incident/accident
☐ Customer complaint
☐ Management Review finding
☐ Staff report
☐ Surveillance finding
☐ Other: _________________
2. Non-Conformity Description¶
| Field | Details |
|---|---|
| Relevant Standard/Clause | _________________ |
| Management System | ☐ Quality (ISO 9001) ☐ Environment (ISO 14001) ☐ Health & Safety (ISO 45001) |
Description of Non-Conformity¶
What did not conform and why?
Evidence¶
Documentary or observational evidence:
Impact Assessment¶
What is the impact or risk?
☐ No immediate impact
☐ Limited impact on operations
☐ Significant risk to quality/environment/H&S
☐ Critical risk to compliance or operations
Details:
3. Root Cause Analysis¶
Method Selected¶
☐ 5 Whys Analysis
☐ Fishbone Diagram (Ishikawa)
☐ Event Tree Analysis
☐ Other: _________________
Root Cause Analysis Detail¶
Why did the non-conformity occur? (Use selected method)
Root Cause Identified:
4. Correction (Immediate Action)¶
Immediate action taken to address the non-conformity:
Who took the action: _________________
Date completed: _________________
Effectiveness of immediate action: ☐ Effective
☐ Partial
☐ Ineffective
5. Corrective Action Plan¶
Actions to prevent recurrence of the non-conformity. Complete at least 1 row; add more as needed.
| Action Required | Responsible Person | Target Completion Date | Resources Required |
|---|---|---|---|
| _________________ | _________________ | _________________ | _________________ |
| _________________ | _________________ | _________________ | _________________ |
| _________________ | _________________ | _________________ | _________________ |
6. Implementation Record¶
Actions Completed¶
| Action | Completion Date | Completed By | Evidence of Implementation |
|---|---|---|---|
| _________________ | _________________ | _________________ | _________________ |
| _________________ | _________________ | _________________ | _________________ |
| _________________ | _________________ | _________________ | _________________ |
Implementation status: ☐ On track
☐ Delayed
☐ Completed
If delayed, reason and revised target date: _________________________
Overall completion date: _________________
Confirmed by (manager): _________________
7. Effectiveness Review¶
Review conducted after implementation to confirm effectiveness:
| Field | Details |
|---|---|
| Review Date | _________________ |
| Reviewed by | _________________ |
| Reviewed by Role | _________________ |
Effectiveness Assessment¶
Is the corrective action effective?
☐ Yes — non-conformity resolved and will not recur
☐ No — non-conformity persists or recurs
☐ Partial — improved but further action needed
Evidence of effectiveness:
Recurrence observed? ☐ Yes
☐ No
If recurrence, describe: _________________________________________________________________
Follow-up Actions (if required)¶
8. Sign-Off & Closure¶
| Role | Name | Signature | Date | Status |
|---|---|---|---|---|
| Raised by | _________________ | _________________ | _________________ | |
| Investigated by | _________________ | _________________ | _________________ | |
| Approved by (Mgr/CEO) | _________________ | _________________ | _________________ | |
| Closed by | _________________ | _________________ | _________________ | ☐ Closed |
Two-tier approval: - CEO (Dragos Ciordas) approves Critical priority CARs - Operations Manager (Sean Ashton) approves High/Medium/Low priority CARs
9. CAR Register Update¶
- ☐ CAR recorded in HREG08 (CAR Register)
- CAR Status:
☐ Open
☐ Pending Implementation
☐ Implemented
☐ Closed
Related Documents¶
- HPROC14: Non-Conformity & Corrective Action Procedure
- HPROC15: Incident Reporting & Investigation Procedure
- HREG08: Corrective Action Register
- HPROC12: Management Review Procedure
- HFORM03: Incident Report Form
Document Footer¶
Retention: 5 years after CAR closure (7 years if compliance-related) Storage: CRGI Secure Document Management System Access: Initiator, Investigator, Responsible Person, Operations Manager, CEO Classification: CRGI Information — Internal Use Only
END OF FORM