Appendix B

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<td colspan="4"><img src="media/image1.wmf" /><img
src="media/image2.wmf" /></td>
<td colspan="12"><strong>Corrective Action Plan (CAP)</strong></td>
<td colspan="6"><p><strong>Form Number:</strong></p>
<p><strong>NP 16-1-2</strong></p>
<p><strong>Page ___ of ___</strong></p></td>
</tr>
<tr class="even">
<td colspan="2">1. CAR No:</td>
<td colspan="5">     </td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="6"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td colspan="3"></td>
<td colspan="15"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="21"><p>2. CAP Proposed Corrective Actions: (Include
attachments as needed)</p>
<p>     </p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="10"><p>Each <strong>CAQ</strong> proposed corrective action
must include the following:</p>
<ul>
<li><p>Name of individual responsible for the action;</p></li>
<li><p>Estimated completion date;</p></li>
<li><p>Remedial actions;</p></li>
<li><p>Investigative actions (extent of deviation and impact on
quality);</p></li>
<li><p>Causal Code(s); and</p></li>
<li><p>Actions to Preclude Recurrence (optional).</p></li>
</ul></td>
<td colspan="11"><p><strong>SCAQs</strong> require the following:</p>
<ul>
<li><p><strong>Items required for CAQ;</strong></p></li>
<li><p>Identification of the root cause of the condition;</p></li>
<li><p>Documentation and results of the root cause determination;
and</p></li>
<li><p>Actions to Preclude Recurrence.</p></li>
</ul></td>
<td></td>
</tr>
<tr class="even">
<td colspan="6">3. QA Approval of Proposed Corrective Actions:</td>
<td colspan="12">     </td>
<td colspan="3">     </td>
<td></td>
</tr>
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<td colspan="6"></td>
<td colspan="4">Print</td>
<td colspan="8">Signature</td>
<td colspan="3">Date</td>
<td></td>
</tr>
<tr class="even">
<td colspan="21">4. CAP Author/SNL WIPP Manager Responsible for
Corrective Actions:</td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="11">     </td>
<td></td>
<td></td>
<td colspan="3">Date:</td>
<td colspan="3">     </td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="4">Printed Name of CAP Author</td>
<td colspan="4">Signature</td>
<td colspan="10"></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="11">     </td>
<td></td>
<td></td>
<td colspan="3">Date:</td>
<td colspan="3">     </td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="4">Printed Name of Responsible Manager</td>
<td colspan="3">Signature</td>
<td colspan="13"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="21">Forward Copy to Manager/Responsible Individual(s) &amp;
Send Original To QATSC</td>
<td></td>
</tr>
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