Quality Deviation Report
Report No.
Date
Reported By
Department
Description of Deviation
Title / Subject
Detailed Description
Date/Time of Deviation
Location
Reference Documents (if any)
Impact Assessment
Potential Impact
Severity
Minor
Major
Critical
Root Cause Analysis
Root Cause
Correction & Corrective Actions
Immediate Correction Taken
Corrective/Preventive Action
Follow-Up/Verification
Follow-up Record
Verified By
Date Verified