Quality Alert Form
Date & Time
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Month
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Day
Year
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Hour Minutes
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PM
AM/PM Option
Quality Tech WWID
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Investigator WWID
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Line
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P1
P2
P3
P4
P5
P7
P8
P9
P10
P11
P12
P13
Nano Cell
U1
U2
RS
AF
Bagger
Rotary 1
Rotary 2
Shop
Slitter
Band Seamer
Tube Seamer
MMC Clipper
Warehouse
Shift
*
1st
2nd
Weekend
Type of Alert
Internal
External
Repeat Quality Issue
Part Number #
*
Shop order #
*
Equipment Involved
*
Disposition
Scrap
Rework
Contain for further review
Quantity Scrapped
*
Quantity Reworked
*
Quantity Contained
*
Short Problem Description
*
Why ? # 1
*
Why ? # 2
*
Why ? # 3
Why ? # 4
Why ? # 5
Material
Media
Metal
Urethane
Hotmelt / Glue
Packaging
Other
Operator
Training
New Employee
Instructions not used
Error in Work Instruction
Methods
No Work Instructions
No Blue Print
Instructions not adapted
Inspection not completed
Packaged wrong
Setup checklist not filled
Environment
Too cold
Too hot
Too humid
Cluttered
Lack of lighting
Equipment
*
Production Line
Pleater
Dispense
Cutter / Welder
Jigs/Molds
Measuring instruments
Root Cause ?
*
Additional Comments (if any) ?
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Action Taken to avoid issue in the future
Action Status ?
Completed
Pending (provide WO # )
Work Order (WO) #
Supvervisor Code
Employee Coached ?
Yes
No
Enter Trainer Name
Enter Trainee Name
Trainee Signature
Quality Alert Disposition
Open
Closed
Quality Manager Closure Code
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