Format No: FM -

NON CONFORMITY REPORT Revision No: 00

Date of Issue : 01/01/2017

Initiated by: Date: Hold Tag NCR No.

Yes  No  NA 

Area/Location Unit/Equip No. Discipline/Responsibility:

DWG. No./Rev. Spec./Rev. Audit No. (If Applicable)

DESCRIPTION OF NONCONFORMANCE

CAUSE CODE(S)
ROOT CAUSE

DISPOSITION /  Use as is  Rework  Repair  Other

Corrective Action

DISPOSITION BY Design Eng. Approval Req.

Construction Engineer Date  Yes  No
DISPOSITION
COMPLETED BY
Contractor Date
Design Engineer Date
ACTION VERIFIED AND NON-CONFORMANCE CLOSED
VERIFICATION METHOD

 DOC REVIEW  INSPECTION  OTHER

AFD INSPECTOR DATE

ELASTOMER (SABIC)-VERIFIED DISPOSITION AND RECOMMENDED CLOSURE OF NCR

AFD SITE QUALITY MANAGER DATE