Defect Type Selection Survey
Help us improve quality by reporting and classifying defects accurately.
Your Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Department / Team
*
Please Select
Production
Quality Assurance
Maintenance
Engineering
Logistics
Other
Date and Time of Defect Observation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Defect
*
Defect Description
*
Defect Type
*
Material Defect
Design Defect
Process Defect
Assembly Defect
Packaging Defect
Other
Defect Severity Rating
*
1
2
3
4
5
Frequency of This Defect
*
First Occurrence
Rare
Occasional
Frequent
Constant
Please indicate how the following aspects were impacted by the defect:
*
Rows
Not Impacted
Slightly Impacted
Moderately Impacted
Severely Impacted
Product Quality
1
2
3
4
Production Efficiency
5
6
7
8
Safety
9
10
11
12
Customer Satisfaction
13
14
15
16
Actions Taken Immediately After Defect Discovery
*
Isolated Defective Item
Informed Supervisor
Initiated Rework
Documented Defect
No Action Taken
Other
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Additional Comments or Suggestions
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