C-201

Deviation and Investigation Procedure Rev 10

Section C — Record Management Revision 10 19 pages

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1.0 Purpose 
 
 The purpose of this procedure is to define the process for documentation of a nonconformance
 or deviation associated with any stage of manufacturing including, packaging, major
 
 processing equipment, instrument failure, discrepancies of controlled good manufacturing
 practice (GMP) documents and failure of facility support systems. 
 
 This procedure defines the process used for initiating, assessing, approving, executing, and
 closing formal investigations of nonconformities and unexpected deviations related but not
 
 limited to products, materials, equipment, processes, and quality systems.
 
 These controls are intended to ensure that nonconforming products and materials are prevented
 from inadvertent use. 
 
 This procedure ensures that disposition decisions are made during management review at
 appropriate levels of the organization. 
 
 2.0 Scope 
 
 This procedure applies to any nonconformities and planned or unplanned deviations that may
 affect products manufactured and/or packaged by Ion Nutritional Labs. 
 
 3.0 Responsibility 
 
 ce | All employees who identify a product, process, or equipment nonconformity or
 
 unexpected deviation, and/or who intend to deviate from an_ established
 process/procedure/specification, are responsible for informing the area supervisor of the
 
 need to initiate a deviation. 
 
 
 

[SOP 

 Standard Operating Procedure SOP No Rev 
 C-201 10 Page 2 of 9 
 Deviation and Investigation Procedure 
 
 3.2 All departments are responsible for providing accurate and timely information, data,
 assessments, and other required input during the investigation. They are also
 
 responsible for active and cooperative participation in the investigation teams as
 requested by Quality. 
 
 3.2.1 The Initiator of the deviation is responsible for ensuring customer notification is
 
 executed as outlined in the Quality Agreement between HBI Ion Labs and the
 customer. 
 
 3.3 Quality is responsible for reviewing and approving all deviations, for determining if a
 deviation is required, for the final review and approval of all deviations, and for
 
 tracking and maintaining deviations. 
 
 4.0 Definitions 
 
 4.1 Deviation — A departure from an approved procedure, process or specification
 
 4.1.1 An unplanned deviation is an unexpected departure from standard operating
 procedure, specification or process which requires investigation, root cause
 
 analysis, impact assessment and corrective actions. Typically discovered after
 the deviation has already occurred. 
 
 4.1.2 A planned deviation is a deviation identified and approved prior to the
 occurrence of the deviation. Typically, a temporary change which may or may
 
 not lead to a permanent change. 
 
 4.2 Nonconformance — The non-fulfillment of a requirement, failure to comply with
 requirements 
 
 4.3 SOP — Standard Operating Procedure 
 
 4.4 BPR — Batch Production Record 
 
 4.5 QC — Quality Control 
 
 
 

[SOP 

 Standard Operating Procedure SOP No Rev 
 Deviation and Investigation Procedure C-201 10 Page 3 of 9 
 
 4.6 MRB — Material Review Board 
 
 5.0 References 
 
 A C-201-F1, Form, Unplanned Deviation Initiation Form 
 
 5.2 C-201-F2, Form, Unplanned Deviation Investigation Form 
 
 5.3 C-201-F3, Form, Unplanned Deviation Closure Form 
 
 5.4 C-201-F4, Form, Planned Deviation Initiation Form 
 
 5.5 C-210-F5, Form, Planned Deviation Closure Form 
 
 5.6 QS-112, SOP, Core Quality Systems and Quality Events 
 
 i QS-112-F1, Form, Quality Event Extension Request 
 
 5.8 QS-112-F2, Form, Quality Event Cancellation Request 
 
 a QS-112-F3, Form, Quality Event Amendment Request 
 
 5.10 C-202, SOP, Material Review Board 
 
 5.11 B-108, SOP, Reprocessing Procedure 
 
 S42 C-403, SOP, Change Control Procedure 
 
 2.13 C-105, SOP, Protocol and Report Document Requirements 
 
 5.14 QS-108, SOP, Corrective and Preventative Action (CAPA) 
 
 5.15 QS-111, SOP, Root Cause Analysis (RCA) 
 
 5.16 QS-114, SOP, Quality Risk Management 
 
 5.17 C-502, SOP, Record Storage, Retention, and Destruction 
 
 
 

[SOP 

 Standard Operating Procedure SOP No | Rev 
 C-201 10 Page 4 of 9 
 Deviation and Investigation Procedure 
 
 5.18 C-501, SOP, Document Control Procedure 
 
 6.0 Procedure 
 
 6.1 General Deviation / Investigation Requirements 
 
 6.1.1 Impact Assessment and Scope 
 
 w Give careful consideration to what a deviation may affect and over
 
 what period of time the deviation may have influence. Consider more
 than just the specific activity. 
 
 6.1.2 Risk Assessment 
 
 ® Quality will follow SOP QS-114 Quality Risk Management when
 
 conducting risk assessments. 
 
 6.1.3 Reprocessing 
 
 # When and investigation finds that a batch or material should or could
 be reprocessed, follow SOP B-108 Reprocessing Procedure.
 
 6.1.4 Quality Review / Approval 
 
 Forms associated with this procedure that require a quality signature
 imply Quality Management. 
 
 % In cases where there is no identified root cause of a deviation, material
 or product quality is in question, or when quality management is
 
 unsure of appropriate next steps, initiate an MRB meeting as indicated
 by SOP C-202 Material Review Board. 
 
 ® Document MRB decisions on the applicable forms (C-201-F1 through
 F5) with MRB signatures as directed by SOP C-202 Material Review
 
 Board. Alternatively, summarize MRB decisions on one document
 
 
 

[SOP 

 Standard Operating Procedure SOP No Rev a 
 Deviation and Investigation Procedure C-201 10 age? 8 
 
 (e.g. a memorandum) with the necessary MRB signatures and attach
 that document to the deviation. Add a Quality management signature
 
 on the deviation forms with reference to the MRB document.
 
 6.2 Unplanned Deviation 
 
 6.2.1 Anyone that identifies an unplanned deviation must inform management of the
 deviation. Use the forms listed below to document and control this process.
 
 6.2.2 C-201 Fl - Unplanned Deviation Initiation Form 
 
 The initiator will complete form C-201-F1 Unplanned Deviation
 Initiation Form. 
 
 ® Take actions necessary to prevent further deviation, harm, or quality
 impact as necessary. If time is of the essence, take action before
 
 initiating the deviation upon management approval. Document actions
 taken on the deviation initiation form. 
 
 o Assign a lead investigator to complete form C-201-F2 Unplanned
 
 Deviation Investigation Form. The lead investigator does not have to
 be the same person that initiated the investigation. The lead
 
 investigator should be familiar with the circumstances and processes.
 For complicated investigations, use an investigation team. The lead
 
 investigator will coordinate the activities of the team and document
 findings. 
 
 6.2.3 C-201 F2 - Unplanned Deviation Investigation Form 
 
 t Investigate the circumstances of the deviation and identify causes of
 the deviation. Follow SOP QS-111 Root Cause Analysis when
 
 conducting this investigation. 
 
 
 

[SOP 

 Standard Operating Procedure SOP No | Rev 
 Deviation and Investigation Procedure C-201 10 Page 6 of 9 
 
 Continue the investigation until satisfied that all information needed to
 resolve the deviation is available. 
 
 Document resolution of the deviation on form C-201-F3 Unplanned
 Deviation Closure Form. 
 
 6.2.4 C-201 F3 - Unplanned Deviation Closure Form 
 
 Upon completion of forms C-201-F1 Unplanned Deviation Initiation
 
 Form and C-201-F2 Unplanned Deviation Investigation Form, Quality
 
 will complete C-201-F3 Unplanned Deviation Closure Form.
 
 If Quality finds that more information is needed to complete the
 
 closure form, Quality may request additional investigative work and
 have the previous forms amended. 
 
 til Planned Deviation 
 
 7.1.3 Evaluate any planned deviation from a procedure, formula, process, or
 
 controlled document before proceeding. Use the forms listed below to
 
 document and control this process. 
 
 7.1.4 C-201-F4 — Planned Deviation Initiation Form 
 
 7.1.4.3 The initiator / requestor of the planned deviation will complete form C-
 201-F4 Planned Deviation Initiation Form. 
 
 7.1.4.4 If detailed instructions are required to execute and control the planned
 deviation, initiate a protocol with this detailed information. See SOP
 
 C-105 Protocol and Report Documentation Requirements for protocol
 documentation requirements. Attach applicable protocols to the
 
 planned deviation. 
 
 
 

[SOP 

 Standard Operating Procedure SOP No | Rev 
 C-201 10 | Page 7 of9 
 Deviation and Investigation Procedure 
 
 7.1.4.5 Conduct a risk assessment to justify the deviation as applicable. See
 SOP QS-114 Quality Risk Management for details about risk
 
 assessments and risk management. 
 
 7.1.4.6 Identify a planned deviation custodian to monitor the planned
 
 deviation. The custodian is responsible for closing the deviation using
 
 form C-201-F5 Planned Deviation Closure Form. 
 
 7.1.4.7 Document and log the planned deviation request as outlined in SOP
 
 QS-112 Core Quality Systems and Quality Events. 
 
 7.1.5 C-201-F5 — Planned Deviation Closure Form 
 
 7.1.5.3. The deviation custodian will initiate form C-201-F5 Planned Deviation
 Closure Form when the deviation is ready to close. 
 
 7.1.5.4 Quality will approve the closure form after confirmation that all
 necessary actions are complete. 
 
 7.2 Additional Requirements from QS-112 Core Quality Systems and Quality Events.
 
 7.2.1 This procedure is a Core Quality System (CQS) that is also controlled by the
 
 CQS and Quality Events SOP QS-112. 
 
 7.2.2 The term “event” is a generic reference to any of the CQS covered by SOP QS-
 
 112 Core Quality Systems and Quality Events. The term “event” is used
 
 interchangeably with specific CQS events as applicable (i.e. “deviation” here).
 
 7.2.3 SOP QS-112 Core Quality Systems and Quality Events provides instructions
 
 common to all Ion Nutritional Labs CQS, including the following topics which
 are not duplicated here: 
 
 7.2.3.1 Assignment of unique event numbers (i.e. deviation numbers)
 
 7.2.3.2 Logging of events with Quality Assurance 
 
 
 

[SOP 

 Standard Operating Procedure SOP No Rev 
 Page 8 of 9 
 Deviation and Investigation Procedure C-201 10 
 
 7.2.3.3 Assignment of event due dates 
 
 7.2.3.4 Event due date extensions 
 
 7.2.3.5 Event cancellations 
 
 7.2.3.6 Event revisions / amendments 
 
 7.2.3.7 Monitoring of open events 
 
 7.2.3.8 Record management and retention instructions 
 
 7.3 Document Maintenance 
 
 7.3.1 Deviations will be maintained following SOPs C-501 Document Control
 
 Procedure and C-502 Record Storage, Retention, and Destruction.
 
 Tue When applicable, original completed deviations will be filed with the batch that
 
 it pertains to. 
 
 8.0 Revision History 

| Rev | Date | Description of Changes | CCR # | By |
|-----|----------|------------------------|-------|----|
| 0 | 05/07/10 | New - - Changed format. Added more definitions. Made SOP more detailed. l 11/29/12 Added a step to document whether or not previously released batches - - may be impacted. Added documentation of material disposition. Clarified and organized SOP. Changed SOP title. Added sections 5.4, | - | - |
| 2 | 02/15/13 | - > 5.5, 5.6, and 5.7. | - | - |
| 3 | 06/13/13 | Organized SOP. Changed forms. - - Replaced Director of Quality and Regulatory Affairs with QA | - | - |
| 4 | 10/15/13 | . Manager. Replaced Management Committee with MRB. Added Form C-201-F3. | 13-869 | H. Peiser |
| 5 | 12/29/14 | Add customer notification; add reference to multiple SOPs; Revise for clarity. | 14-1017 | D. Popp |
| 6 | 01/05/16 | Remove manual logs and files; expand responsibilities to Quality Management or designee. > 03/01/17 Revise to clarify Raw Material Quarantine process; revise to clarify 17-0214 D. Popp proper maintenance of closed deviations. | 16-0029 | D. Popp |

 
 

[SOP 

 Standard Operating Procedure SOP No Rev 
 Deviation and Investigation Procedure C-201 10 Page 9 of 9 
 
 Revise to align with new forms C-201-F1, C-201-F2, C-210-F3, C-
 01/14/20 19-0600 K. Burris 
 201-F4, C-201-F5. Removed raw material quarantine form. 
 Updated logo and format. Corrected typos. Added additional SOP 
 09/18/23 references. Added documentation requirements. Added SOP and form CC-23-0469 K. Burris
 names. 
 |.Update the Header and footer to HBI Ion Labs on each document
 2. Update C-201 to specify responsibility for notification of customer
 per Quality Agreement 
 3. Update Definition of Deviations 
 10 07/05/25 4, Update C-201-F1 to include customer in notifications section and F2 CC-25-0364 | P. Christensen
 to include date notified field and instruction to attach evidence.
 5. Update C201-F3 to specify (Completed by the Deviation Custodian
 and/or Quality) for each section. 
 6. Update 7.2.3.2 to specify Quality Assurance 
 
 
 

[SOP 

 Unplanned Deviation Initiation Form 
 
 Form: C-201-F1 CCR No. CC-25-0364 Revision: 2 
 
 Deviation # 
 
 Section I — Unplanned Deviation Information 
 Deviation Overview (Completed by the Initiator) 
 
 Initiator’s Name: Department: 
 Observer’s Name: Department: 
 Deviation Title 
 (Short description) 
 Description of the Deviation: (Include details like who, what, when, where, and why associated with the deviation. As
 applicable include sequence of events, background information, cross references to protocols, etc. Include details like room
 numbers, lot numbers, material names and numbers, product names and numbers, etc.)
 
 Deviation Details (Completed by the Initiator) 
 Date & Time (if known) deviation occurred: 
 Date / Time deviation initiated: 
 
 [1 N/A (Reason for a delay between date of occurrence and initiation if greater than 2 business days
 
 Deviation Type: Specify what was deviated from: (procedure number,
 C) Deviation from Procedure specification, standard, equipment function, etc.)
 [1] Non-conforming material/product/result/data 
 (J Deviation within facility/services/environment 
 C] Deviation from regulations 
 
 [J Adverse trend detected 
 (J Other, Specify: 
 What may be affected by the deviation? (Completed by the Initiator) 
 
 
 

[SOP 

 Unplanned Deviation Initiation Form 
 
 Form: C-201-F 1 CCR No. CC-25-0364 Revision: 2 
 
 Deviation # ! | 
 
 Item Detail 
 C] Equipment ID 
 [J Process/Specification 
 [J Product (SKU/Name/Batch#) 
 
 [] Material (Item#/R#) 
 [J Standard 
 (J Other 
 
 Discuss potential impact of this deviation including process, products, materials, etc.
 (Note: Impact may change after investigation is completed) 
 
 Initial Action(s) Taken (Completed by the Initiator) 
 
 Notifications (check all that apply) Quarantine / Tag Out / Hold
 [J QA [CJ QC Lab [J Executive Management C] N/A 
 [J QC Inspectors C1 R&D C) Customer notification is required C) Yes (explain below)
 [J QC Doc Control (] Prod. Management per Quality Agreement [] No (explain below)
 
 Describe immediate action taken to correct the deviation or nonconformance and to provide detail for boxes above.
 
 Deviation Assignment (Completed by the Initiator and/or Quality) 
 Lead Investigator Role Deviation 
 Assigned to Due Date 
 
 Approval Signatures 
 Name Title Signature Date 
 Completed By: 
 (Initiator) 
 Assignment Accepted By: 
 C] N/A if same as completed by 
 Approved By: 
 (Quality) 
 
 
 

[SOP 

 Unplanned Deviation Investigation Form 
 
 Form: C-201-F2 CCR No. CC-25-0364 Revision: 2 
 
 Deviation # | 
 
 Section II — Unplanned Deviation Investigation 
 
 Deviation Overview (Completed by the Investigator) 
 Deviation Title 
 Short description 
 
 Investigation Activities (Completed by the Investigator) 
 The following activities were used to conduct this investigation (check all that apply):
 Interviews (list interview personnel interviewed and key findings below) 
 Document reviews (list documents reviewed and key findings below) 
 Observations — (list observations and key findings below) 
 Testing / Inspection (list activities and results below) 
 Five (5) Whys review (list questions and answers below) 
 Other (specify below) 
 OROUOUOO 
 Add detail information to the impact assessment selected above as applicable. 
 [J Attached [J] Discussed here 
 
 
 

[SOP 

 — Unplanned Deviation Investigation Form 
 
 Form: C-201-F2 CCR No. CC-25-0364 Revision: 2 
 
 Deviation # 
 
 Causes and Root Cause Identified (Completed by the Investigator) 
 List likely causes of this deviation and identify the most likely root cause. See SOP QS-111 for Root Cause Analysis
 [1 Attached (J Discussed here 
 
 Investigation Summary and Conclusions (Completed by the Investigator) 
 Summarize this deviation investigation and conclusions. 
 [] Attached [J] Discussed here 
 
 Approval Signatures 
 Note: Quality should not approve this investigation unless it is thorough enough for Quality to complete form
 C-201-F3 to close this investigation. Specifically, Quality will need to make Impact and Quality assessments as well as
 determine CAPA. This investigation must provide details necessary for these determinations.
 Name Title Signature Date 
 Completed By: 
 (Investigator) 
 Approved By: 
 (Quality) 
 
 
 

[SOP 

 ae Unplanned Deviation Closure Form 
 @)HBI 
 i Form: C-201-F3 CCRNo. —CC-25-0364 Revision: 2 
 
 Deviation # : | 
 
 Section ITI — Unplanned Deviation Closure 
 
 Deviation Overview (Completed by the Deviation Custodian and/or Quality) 
 Deviation Title 
 Short description 
 Impact Assessment (Completed by the Deviation Custodian and/or Quality) 
 Review the “What may be affected by the deviation?” section of form C-201-F1 for this investigation. Based on the
 investigation of the deviation completed on form C-201-F2, select impact statements listed below (check all that apply).
 NOTE: this is a scope assessment, not a quality or disposition assessment. 
 (-] All items identified at deviation initiation are still impacted by this deviation.
 [_] Some items identified at deviation initiation are no longer impacted by this deviation. (list below)
 [-] Some items are impacted by this deviation that were not identified at deviation initiation. (list below)
 Add detail information to the impact assessment selected above as applicable. 
 [I N/A (CJ Attached [1 Discussed here 
 
 Quality Assessment (Completed by the Deviation Custodian and/or Quality) 
 Based on the investigation of the deviation completed on form C-201-F2, select quality statements listed below (check all
 that apply): 
 All items identified in the impact assessment above meet applicable quality standards and/or specifications and may be
 considered for release or continued use. 
 [] Some items identified in the impact assessment above meet applicable quality standards and/or specifications and
 some do not. Describe findings and disposition decisions below: 
 [J All items identified in the impact assessment above do not meet applicable quality standards and/or specifications and
 may be considered for release or continued use. 
 Add detail information to the quality assessment selected above as applicable. 
 []N/A LJ Attached LJ Discussed here 
 
 Risk Assessment (Completed by the Deviation Custodian and/or Quality) 
 The impact assessment and/or quality assessment is based on the following risk assessment in addition to the information
 provided in the investigation of this deviation C-201-F1. The process of risk assessment is governed by SOP QS-114.
 [] The conclusions are not complicated and no additional risk assessment required.
 [] Additional risk assessment was performed (see below) 
 Add detail information to the risk assessment selected above as applicable. 
 LI N/A CJ Attached (J Discussed here 
 
 
 

[SOP 

 r sa Unplanned Deviation Closure Form 
 
 Form: C-201-F3 CCR No. CC-25-0364 Revision: 2 
 
 | 
 Deviation # | 
 
 Notifications / Additional Actions (Completed by the Deviation Custodian and/or Quality)
 Are any notifications or additional actions required based on this Deviation 
 [] No additional notification or action required. 
 [1 Customers notification, date notified (attach evidence) 
 [] Additional action required. 
 Add detail information to the quality assessment selected above as applicable.
 [LIN/A (1 Attached [1 Discussed here 
 
 Attachments (— List all attachments applicable to this investigation. Include attachments from forms C-201-F1 and
 C-201-F2 as well as this closure form C-201-F3. 
 Title Description Pages 
 
 CAPA (Corrective Action(s) and Preventative Action(s) — (Completed by the Deviation Custodian and/or Quality)
 Is there evidence of repeated observations or patterns? 
 [1] No-—CAPA may be required — complete additional CAPA sections below as applicable. If at least one CAPA is not
 initiated, explain that decision in the space provided for CAPA below. 
 [1 Yes — CAPA is required — complete addition CAPA sections below. 
 List CAPA already completed and in place before closure of this form 
 
 List CAPA yet to be completed. These must have CAPA numbers and are managed by SOP QS-108
 
 Approval Signatures 
 Name Title Signature Date 
 Completed By: 
 
 Approved By: 
 (Quality) 
 
 
 

[SOP 

 Planned Deviation Initiation Form 
 oS BHeeaalutthy & 
 Innovations Form: C-201-F4 CCR No. CC-23-0469 Revision: 2 
 
 Deviation # 
 
 Section I — Planned Deviation Information 
 
 Deviation Overview (Completed by the Initiator) 
 Initiator’s Name: Department: 
 Deviation Title 
 Short description 
 Description/Reason/Justification of the Planned Deviation: (Include details like who, what, when, where, and why
 associated with the planned deviation. As applicable include sequence of events, background information, cross references
 to protocols, etc. Include details like room numbers, lot numbers, material names and numbers, product names and numbers,
 etc.) 
 
 Deviation from what? (Completed by the Initiator) — check all that apply 
 L] Deviation from Procedure(s) 
 _} Deviation within facility/services/environment 
 L] Deviation from regulations 
 
 [_] Other (specify) 
 Add detail information to the scope check boxes selected above as applicable. 
 LIN/A LJ Attached LJ Discussed here 
 
 
 

[SOP 

 Planned Deviation Initiation Form 
 ~~ HBeeaalutthy & 
 Innovations 
 Form: C-201-F4 CCR No. CC-23-0469 Revision: 2 
 
 Deviation # | | 
 
 Deviation Scope (Completed by the Initiator and/or Quality) — check all that apply
 Note: A due date (see custodian assignment) will be assigned to this planned deviation regardless of the scope identified below. The
 due date will create a mechanism to check on the progress toward closing this planned deviation.
 |] Specified Time Frame Start | | End | 
 L] Specified Product(s) or Material(s) 
 L] Specified Locations Rooms or Areas 
 
 [_] Specified Systems or Procedures 
 _] Until specified action is complete 
 _] Other (specify) 
 
 Add detail information to the scope check boxes selected above as applicable. 
 LJ N/A (J Attached (I Discussed here 
 
 What may be affected by the deviation? (Completed by the Initiator and/or Quality)
 Item Detail 
 L] Same as deviation scope 
 L] Equipment ID 
 L] Process/Specification 
 LI Product / Material (Item # / 
 Name / Batch#) 
 CL] Other 
 
 Discuss potential impact of this planned deviation including process, products, materials, etc.
 LIN/A (CJ Attached (J Discussed here 
 
 Notifications / Additional Actions (Completed by the Initiator and/or Quality) 
 Are any notifications or additional actions required based on this Deviation 
 L] No additional notification or action required. 
 [] Clients / Customers notification is required 
 L] Additional action required. 
 Add detail information to the quality assessment selected above as applicable. 
 L]N/A CJ Attached UC Discussed here 
 
 
 

[SOP 

 Planned Deviation Initiation Form 
 oa BHeeaalutthy & 
 Innovations 
 Form: C-201-F4 CCR No. CC-23-0469 Revision: é 
 
 Deviation # 
 
 Planned Deviation Implementation Controls (Completed by the Initiator and/or Quality)
 How will the planned deviation be implemented and processes controlled (check all that apply)
 L] Documented training on this planned deviation 
 [J Issuance of hand corrected documentation and quarantine of currently approved documentation
 L] (Tags / Markers / Signs) on equipment, controls, rooms materials, product, documents, etc.
 [} Other 
 Add detail information to the quality assessment selected above as applicable. 
 LIN/A (CJ Attached (Discussed here 
 
 CAPA (Corrective Action(s) and Preventative Action(s) — Completed by the Initiator and/or Quality)
 Is there evidence of need to make this deviation permanent? 
 L] No—CAPA may be required — complete additional CAPA sections below as applicable.
 
 L] Yes—CAPA is required — complete addition CAPA sections below. 
 List CAPA already completed and in place before closure of this form 
 
 List CAPA yet to be completed. These must have CAPA numbers and are managed by SOP QS-108.
 
 Deviation Custodian Assignment — (Completed by the Investigator and Quality) 
 The deviation custodian is responsible for monitoring and closing this planned deviation.
 Deviation Custodian Role Deviation 
 Assigned to Due Date 
 Approval Signatures 
 Name Title Signature Date 
 Completed By: 
 (Initiator) 
 Assignment Accepted By: 
 L] N/A if same as completed by 
 Approved By: 
 (Quality) 
 
 
 

[SOP 

 Planned Deviation Closure Form 
 @HBI 
 Form: C-201-F5 CCR No. CC-25-0364 Revision: 2 
 
 Deviation # 
 
 Section II — Planned Deviation Closure 
 
 Deviation Overview (Completed by the Deviation Custodian and/or Quality) 
 Deviation Title 
 (Short description) 
 Deviation Scope Completion (Completed by the Deviation Custodian and/or Quality)
 Was the deviation Scope defined on C-201-F4 met? 
 L] Yes, all aspects of the deviation scope were met. 
 [] No, all aspects of the deviation scope were not met. Discuss why the deviation is to be closed and impact of closure
 before the scope requirements are met. 
 Add detail information to the scope completion assessment selected above as applicable.
 [] N/A CJ Attached [J Discussed here 
 
 Deviation Implementation Controls Removal (Completed by the Deviation Custodian and/or Quality)
 Review the planned deviation controls implemented in C-201-F4 and ensure that they are removed upon finalization of
 this closure form. (check all that apply) 
 [] Implementation controls have been removed and previous procedure / process are in place.
 
 [] Implementation controls have been removed and new procedures / processes are in place.
 L] Other 
 Add detail information to the status of implementation controls selected above as applicable.
 [] N/A (J Attached LJ Discussed here 
 
 Additional Actions (Completed by the Deviation Custodian and/or Quality) 
 Are any additional actions required before closing this planned deviation? 
 L] No additional action required. 
 [] Additional action required. 
 
 Add detail information to the quality assessment selected above as applicable. 
 CIN/A (J Attached (J Discussed here 
 
 Approval Signatures 
 Name Title Signature Date 
 Completed By: 
 (Author) 
 Approved By: 
 (Quality)