Bloomer Quality Alert Form
Rev C
Date*
Month Day Year
Time*
: Hour Minutes AM/PM Option
Quality Tech WWID*
Investigator WWID*
Line*
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) ?
Image #1
Image #2
Mfg Engineering Code
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
Please Run the Wizard
Trainee Signature
Clear
Quality Alert Disposition
Open Closed
Quality Manager Closure Code
Should be Empty: