Deviation Request Form

Formalize a request to depart from a product or service's agreed specifications, along with the justification and corrective actions involved.

Use this template

Name

First Name

Last Name

Email

Phone Number

Part Number

Description

Revision Level

Purchase Order Number

Number of Parts Affected

Deviation Request

Permanent Temporary One-time

Indicate the characteristic, the requested deviation value, and the proper units

Reason for Deviation

Describe the corrective action taken to prevent similar deviations in the future

Describe the preventive action needed to avoid similar deviations in the future

Name

First Name

Last Name

Situation of Deviation

Approved Rejected Pending

Conditions/restrictions for use of the deviated material

Reason for Rejection

Signature

Sign here

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