Initiated by:Date: 反馈方：日期:Issued to:
Team Members:发送至：
团队成员：Vendor:
Due Date: 供应商:
提交时间:
品名:
不良说明:
Root Cause:
补救措施：
改善方案：
Verification Effectiveness of Corrective Action:
确认改善方案的效果
Preventive Action:
预防措施
Was Corrective Action Effective? Yes:______No:_______是:_____不是: _______Process/Part #: Interim / Containment Action:
Process/Part Name: Reference Documents (RMA, Customer/Supplier Report, Correspondence,etc.):
参考文件（RMA,客户/供应商报告，联系方式等）
Description of Non Conformance:
不良原因分析:
Corrective Action:
改善措施是否有效：Mikros CAR #
Mikros 品质改善报告编号:
Customer Name 客户编号：Mikros Engineering Inc.
Custom Injection Molding & Manufacturing Services
8755 WYOMING AVENUE NORTH · BROOKLYN PARK, MN 55445
Corrective / Preventive Action Request
零件号:Form Sent to
Vendor：回馈方式/
供应商联系人: 品质改善报告
Sales Approval: 销售联系人:Vendor Contact:
Date Closed: Verification Effectiveness Reviewed By
审核人：结束日期：