Corrective Action Plan
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3Corrective Action Plan
NC#:_______
Section 1: Item not in compliance:
Source and Description of Non-Compliance:
□
Pre-Inspection Questionnaire Item #:_____
□
Inspection Questionnaire Section:_______________________________________ Item #:_____
□
□
Potential Threat
Yes
No
□
□
Repeat Non-compliance
Yes
No
Related Medical Standard:__________________________________________________________
Description of non-compliance (
Include as much detail as possible. Attach documentation that may be relevant to
:
specific non-compliance)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Section 2: Eye Bank Corrective and Preventive Action Plan:
Possible Root Cause
:
(Describe, in your eye bank’s opinion, the potential root cause of the non-compliance)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Document Revised June 2016
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