QACO-018-Rev-02
QUALITY ASSURANCE AND COMPLIANCE
OFFICE
CONTINOUS QUALITY IMPROVEMENT PROGRAM
CORRECTIVE AND PREVENTIVE ACTION REPORT (CPAR)
REFERENCE NO: __________________________________________
Type of Non-conformity
Service Quality
Patient Complaint
Patient Safety and Occupational hazard
Sentinel Event
Infection Prevention and Control
Quality Documentations
Data Privacy and Security
Others:
FINDINGS/
NON-CONFIRMITY
CORRECTIVE ACTION/s
(Immediate)
*may use the back page
PREVENTIVE ACTION/s
(Action/s taken to prevent
or reduce likelihood of
occurrence)
*may use the back page
ACCOMPLISHED BY:
Name/Signature
Date/Time
Name/Signature
Date/Time
DATE DUE FOR MONITORING:
DEPARTMENT HEAD:
QACO PORTION TO FILL
VALIDATION DATE:
DESPOSITION
CPAR CASE: OPEN
CLOSE
REMARKS: Effectiveness of the action taken after due date
Validated by:
Date:
RE-OPENED
CAUSE:
Cause:
Time:
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