INTERNAL NON CONFORMANCE REPORT

Observer / Section Tim Site Asam-Asam NCR Serial No. WTA/SITE-QC/01/2021

To Person/Section QC Fabrikasi NCR Issue Date 18/01/2021
Project KALSELTENG 2 Job No.
Subcontractor PT. Waduk Tirta Asih Location PLTU ASAM ASAM

Drawing No . : WTA-CFSPP-001-AD-C5-2 Rev. Date PQP Location NCR Other

Reference No. Category Reference
Client Document No. :
PT. WTA F-09

DESCRIPTION OF NON CONFORMITY / SKETCH ( IF NECESSARY ) /

JELASKAN APA YANG TIDAK SESUAI SKETSA ( BILA PERLU )
Ditemukan ketidaksesuaian posisi aksesoris (gusset) pada kolom C5-2

OBSERVER
mengakibatkan girder ( G-14C7 ) tidak terpasang dengan benar

Ganjar Herry Siswanto

OBSERVER SUPERIOR

VALID INVALID SIGNED BY NCR COORDINATOR :

NCR COORDINATOR
REMEDIAL ACTION TO BE TAKEN ( DISPOSITIONS ) ( TO BE FILLED BY NCR COORDINATOR )
ON OR BEFORE DATE :
SEGREGATE WITH NCR STICKER √ REPAIR REGRADE

REWORK SCRAP REVISE

USE AS IT IS CLIENT APPROVAL RETURN TO OTHER

SUPPLIER OR CLIENT

RECEIVER COMMENTS / PENDAPAT PENERIMA NCR

RECEIVER
RECEIVER SIGN DATE

DISPOSITION COMPLETION DATE : RESULTS : ACCEPT / REJECT BY OBSERVER

COMMENTS

REINSPECTION : YES / NO
Cost of Non Conformity ( CON ) : CON ( Cost of Non Conformity )
......... Mhr x ......... = Rp.
RECEIVER

Material = Rp. Charge To :

Consumable = Rp.
Equipment = Rp. Approved by :
Others = Rp.
CON Total = Rp.

CONCLUSION :
NCR COORDINATOR

NCR CLOSED CLIENT APPROVAL REF. NCR STILL OPEN

NEED TO RAISE CAR
IF YES , STATE CAR No. REVIEWED & ACCEPTED BY AI
( IF REQUIRED ) STAMP

NCR COORDINATOR SIGN AUTHORIZED INSPECTOR

For NCR Category , see behind this page C:msd\dini\form\ncr.xls