Form No.

: MTD-QPF-03-01

Rev. No.: 0 Date: 03-05-06

NON-CONFORMING REPORT
ISSUED TO: NCR No.: DATE:

NON CONFORMITY TYPE

Sales/Marketing Customer Service Assembly Delivery Servicing QC Others

NON CONFORMITY MAGNITUDE Major Minor Observation

DESCRIPTION :

AT VARIANCE TO DOCUMENT/STANDARD:

INITIATED BY :
TITLE SIGNATURE DATE

CAUSE OF NON-CONFORMITY:

EVALUATED BY :
TITLE SIGNATURE DATE

CORRECTIVE ACTION
Rework Accept with Rectification Regrade Reject

PROPOSED BY
TITLE SIGNATURE DATE

PREVENTIVE ACTION (IF APPLICABLE)

PROPOSED BY
TITLE SIGNATURE DATE

CONCLUSION SIGNED IN CONFIRMATION OF EFFECTIVENESS OF CORRECTIVE/PREVENTIVE ACTION

TITLE SIGNATURE DATE

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