Quality Alert Form

Bloomer Quality Alert Form
Rev C
Date*
MonthDayYear
Time*
:HourMinutesAM/PM Option
Quality Tech WWID*
Investigator WWID*
Line*
Shift*
1st2ndWeekend
Type of Alert
InternalExternalRepeat Quality Issue
Part Number #*
Shop order #*
Equipment Involved*
Disposition
ScrapReworkContain for further review
Quantity Scrapped*
Quantity Reworked*
Quantity Contained*
Short Problem Description*
Why ? # 1*
Why ? # 2*
Why ? # 3
Why ? # 4
Why ? # 5
Material
MediaMetalUrethaneHotmelt / GluePackagingOther
Operator
TrainingNew EmployeeInstructions not usedError in Work Instruction
Methods
No Work InstructionsNo Blue PrintInstructions not adaptedInspection not completedPackaged wrongSetup checklist not filled
Environment
Too coldToo hotToo humidClutteredLack of lighting
Equipment*
Production LinePleaterDispenseCutter / WelderJigs/MoldsMeasuring instruments
Root Cause ?*
Additional Comments (if any) ?
Image #1
Image #2
Mfg Engineering Code
Action Taken to avoid issue in the future
Action Status ?
CompletedPending (provide WO # )
Work Order (WO) #
Supvervisor Code
Employee Coached ?
YesNo
Enter Trainer Name
Enter Trainee Name
Trainee Signature
Clear
Quality Alert Disposition
OpenClosed
Quality Manager Closure Code
Should be Empty:

Bloomer Quality Alert Form