NON-CONFORMANCE REPORT

JOB DETAILS
Customer: Kirby Job No:
IDENTIFICATION

Location: Date:
NON-CONFORMANCE
Works Concerned /
Location / Section:
REQUIREMENT(S)
/References:

DESCRIPTION OF
NON-
CONFORMANCE:
STEP 1 :

Material
POSSIBLE ROOT Manpower
CAUSE: Design
Method
Process
Other

Attached
Documents:

REMEDIAL WORKS
PROPOSAL / REPAIR
CORRECTION:
REJECT

CLOSURE DATE:
PREVENTIVE
STEP 2 : REMEDY

ACTION (to avoid

recurrence):
REVIEW by DESIGNER (if required):

Name: Position: Date: Signature:

CLIENTS APPROVAL ON REMEDIAL WORKS / CORRECTION
Comments:

Name: Date: Signature:

COMPANY:
RESPONSIBLE FOR THE CLOSURE OF NCR:
PERSON:
STEP 3 : CLOSURE

VERIFICATION OF CLOSURE OF THIS NCR / INSPECTION

Attachments
:

RESPONSIBLE PERSON CONTRACTOR CLIENT

Comments:
Name:
Date:
Signature:

Form Codification : Page 1 of 1 Date of issue of Form :