Doc No.
Issue Date :
Corrective and Preventive Action Revision No.:
JKT FW-
Date : Issuer: KN Code:
QA
Customer: Date of receiving Customer Feedback:
Type of Problem / Issue :
Invoicing (wrong, late, etc.)
Damage / Loss Late Arrival / Delivery
Communication Failure Suggestion
Internal Service Failure Carrier / Subcontractor Problem
Health & Safety issue Environmental issue
System Problem
Others
Definition of Problem / Issue :
Note: specified and / or attached supporting / affected document if any
Root Cause Analysis :
Corrective / Preventive Action:
Note: specified and / or attached supporting / affected document if any
Problem Owner
External Parties
Name
Issuer : Reviewer : Owner : Page 1 of 2
* QSHE = Quality, Safety, Health, Environment UNCONTROLLED document if printed Last updated April 15, 2023
Doc No.
Issue Date :
Corrective and Preventive Action Revision No.:
Date
Sign
Team Member Team Member
Department Manager
(If any) (If any)
(MJI Code / BU)
Name
Date
Sign
Verified by / MJI Code / Date
(QSHE )
Approved by / MJI Code / Date
( QSHE )
Comments (If any)
Issuer : Reviewer : Owner : Page 2 of 2
* QSHE = Quality, Safety, Health, Environment UNCONTROLLED document if printed Last updated April 15, 2023