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Document Number MKAKB/BP/BR-12
Issue Number 01
Amendment Number 02
Issue Date 01.09.2023

Corrective Action Request (CAR) Disease Sector MKA KB

Initiated by:

Unit: Date:

Category of Non-conformance (Please tick)

Pre-analytical Other (Please specify)
Analytical Post-analytical ………………………………..

1. Description of non-conformance (attach evidence if available, i.e.: photo, request form, asset no., etc):

Raised by: Date:
2. Correction(s) for the obvious cause (immediate actions to regain control and containment to eliminate the
detected NC) (attach evidence if available, i.e.: Work Order no., etc):

Action taken by: Date:

3. Evaluation of the significance

Significant and require CA Not significant

Evaluation performed by HOU/HOS: Date:

4. Description of the root cause(s)
Note: Root cause of an NC - Man, method, machine, material, environment, time, others

Determined by HOU/HOS: Date:

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