(Company Name)
Request for Deviation
RFD# (issued by (Company Name)): Deviate from:
RFD Part Process
RFD Title:
Description of Deviation: Reason for Deviation:
Corrective Action taken to resolve issue: Impacts & Risks:
PO Number(s): Work Order(s) #: ECR Number: NCR Number:
Created by: Origination Date (m/d/y): Expiry Date (m/d/y):
This Deviation applies to the following:
Part # Revision Quantity Serial #
APPROVAL:
Name (print): Signature: Date (m/d/y):
Doc No. QMS-FM-0032 Rev. I Page 1 of 1