A2LA ACTION REQUEST FORM

A2LA ACTION REQUEST FORM

INSTRUCTIONS: Please print this form, complete Part I, and then fax to: Ms. Teresa Adams at FAX # 301 662 2974.

Part I - To be Completed by Action Requestor

Name of Requestor:

Date:

Phone:

E-mail Address:

Type of Action Request: check only one - see below for more details on the categories

___ Idea for Improvement ___ Preventive Action ___ Complaint ___ Departure Request ___ Nonconformance

Describe issue below and/or check here ____ if letters/documents are attached ( ____ # of pages)

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Identify the Relevant A2LA Requirement/Policy/Clause (if applicable):

______________________________________________________________________________________

In the section below, identify possible solutions that might resolve the issue.

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Ideas for Improvements: ideas for improving all aspects of A2LA operations.

Preventive Action: needed improvements and potential sources of non-conformances. Preventive action is a pro-active process to identify opportunities for improvement rather than a reaction to the identification of problems or complaints.

Complaint: internal and external problems or disputes.

Departure Request: to request a departure from the policies and procedures documented in the A2LA quality system.

Nonconformance: to be cited when a departure from policies and procedures in the A2LA quality system has been identified and no prior approval for the departure was given.

Part II - to be completed by A2LA Staff:

Reviewed by QM:

Date:

Assigned To:

Date Receipt was Acknowledged to Requestor:

Investigation & Identification of Potential Causes:

______________________________________________________________________________________

Identify Possible Corrective Actions:

______________________________________________________________________________________

Action Taken to Correct:

______________________________________________________________________________________

Action Taken to Prevent Recurrence:

______________________________________________________________________________________

Name: ___________________________ Signature ______________________ Date ___________________

Method of Feedback to Requestor:

Date feedback was provided:

Closure:

Quality Manager: _________________________ Date: _______________

President: _______________________________ Date:________________