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Preventive Action Report
Quality Document QD85-03 Rev.15.0 – Rev.Date 20/01/15 Page 1 of 2
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Date
Originated By
PAR No.
Responsible Person Responsible Department
Business Action Identified Suggested Preventive Action
Received by Quality Manager Date
Projected Dates for Action Short Term Long Term
Follow Up and Close Out
Follow Up Action Close Out Action
Reported by Date