Sample - Corrective Action Report Form
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1WORKPLACE INSPECTIONS
SAMPLE - CORRECTIVE ACTION REPORT FORM
Department/Unit/Site Inspected:_______________________________
Date and Time of Inspection:______________
OBSERVATION
FOLLOW UP
Inadequate Condition
Recommended
Person
Action Taken
Date Action
Signature
Identified and specific
Corrective Action to
Responsible
Completed
location (eg: Room #)
be Taken
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Inspection performed by:____________________
_________________________
_________________________
Signature of Manager: ____________________________
Date: ____________________________
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Parent category: Legal