Attachment 2_Corrective Action Process Form_04 December 2025.pdf

Corrective Action Request Form

Section 1: CAR Initiation This Section to be completed by the Government.

Tracking Number:

Contract Number:

CAR Level I/II/III/IV:

Date: Identified by (APT Member and Unit):

Date: Issued by (COR/GFR/AGFR):

Response Due Date (45 days from issue date):

Issued to (Contractor Site Lead):

Description of the problem (Filled out by APT Member):

Evidence:

Requirement:

Statement of Nonconformity:

Contractor’s Root Cause Analysis (RCA) needed? Yes No (RCA may not be required for Level I CAR)

Section II: Investigation and Action This section to be completed by the affected Contractor if RCA box directly above is checked “Yes”.

Root cause of the actual or potential problem: (How/Why did this happen?)

Action needed? Yes No (If “Yes” is checked, fill out the rest of Section II)

Correction (fix now) with completion dates:

Corrective Action (to prevent recurrence) to be taken:

Estimated completion date:

This section to be completed by the affected Site Lead - after initial correction is completed.

Action completed by: Date completed:

Section III Follow-Up and Closure This section is to be completed by initiating Government after action is completed.

Results of immediate action taken:

Was the action effective? Yes No Explain:

Document any further details if contractor’s initial action was not effective, their RCA was unacceptable, or their proposed action to prevent recurrence was unacceptable. If Corrective Action Plan is acceptable, state that clearly:

Results reviewed by: Date closed:

CAR form emailed to PMA-266 GFR with recommendation to close out? Yes No

Date:

Unit GFR/AGFR signature:

CAR form closed out (PMA-266 GFR/COR)? Yes No Date:

COR Signature: