PT. KARYAINDAH ALAM SEJAHTERA Document No. : FM/KIAS-MR/01.

20
MANAGEMENT REPRESENTATIVE Revision No. :5
NON CONFORMITY REPORT Issued Date Form : 22 Mei 2018

PRODUCT IDENTIFICATION NC Form No : 029/PACK-KIAS/04.21

Issued Date : 12.04.2021
Date of Incoming Product : 10.04.2021
Manufacturer : PT. Bumimulia Indah Lestari

Truck/Cont No. : L 8002 KF & L 8079 WU

Product Type : Jerrycan Kuning 25 ltr (211040007)
Quantity : 1152 & 1152 pcs Lot Size :-
Original package : 144 & 144 bundel (8 pcs @bundel) Sample Size : -
Sampling Method :-
Sample Size Code :-

DETAILS OF NON-CONFORMANCE
Ditemukan pada saat proses produksi tanggal 10 April 2021, Reported by,
- Inner berlubang sebanyak 22 pcs dengan kode produksi terlampir.
- Terdapat perbedaan / ketidaksesuaian antara kode produksi inner & outer
yang tertulis di CoA dengan aktual kedatangan Achmad Feri
12/04/21
Kode produksi aktual kedatangan (QC Incoming) - (sign, name, date)
- Inner - Outer
Tgl Prod : 11/11/20 & 16/11/20 Tgl Prod : 20/04/20 & 21/04/20
MC No : I – 03 MC No : I - 42
Status Approved by,
PRODUCT STATUS: (Include internal disposition - if necessary)

USE AS IT REJECT SORTING

(PPIC - KIAS) - (sign, name, date)
DETAILS FOR STATUS:
(please explain detail reasons for the selection status)
Reviewed by,

Siska Ratna
12/04/21
(LAB DEPT.) - (sign, name, date)

SUPPLIER'S FEEDBACK
ROOT OF CAUSE:

PREVENTIVE ACTION:

Date :
Prepared by,

Supplier - (Sign & Name)

Inner Berlubang dengan Cavity 1.5 sebanyak 22 pcs
Inner Berlubang dengan Cavity 1.5 sebanyak 22 pcs

Kode Produksi