Customer Complaint Record

1. Complaint Information

Date Received:

Received By:

Customer Name:

Contact Info (optional):

How Received: Email Phone In-Person Social Media Other: __________

2. Product Information

Product Name:

Batch/Lot Number (if known):

Purchase Date (approx):

Purchase Location:

3. Complaint Description

Customer's Description of Issue:

Type of Complaint:
Product quality (appearance, texture, odor) Product performance
Skin reaction/irritation Packaging issue
Labeling concern Other: __________________

4. Severity Assessment

LOW
Minor quality issue MEDIUM
Possible health concern HIGH
Adverse reaction

MoCRA Requirement: Serious adverse events must be reported to FDA within 15 business days.

5. Investigation

Investigation Steps Taken:

Batch record reviewed
Retention sample examined
Raw material lots checked

Similar complaints checked
Production conditions reviewed
Product returned for inspection

Findings:

Root Cause (if determined):

6. Corrective Action

Immediate Action Taken:

Preventive Action (to prevent recurrence):

Customer Resolution:
Refund issued Replacement sent Explanation provided No action (unfounded) Other: __________

7. Follow-Up & Closure

Customer Contacted: Yes No N/A

Date of Follow-Up:

Date Closed:

Closed By:

Signature / Date

Retention: Keep complaint records for at least 3 years. Review complaint trends periodically.