Document : GSB – Form – 58

Revision : 01
NON CONFORMING REPORT( NCR ) Page : of
Date : 02 January 2013

PROJECT :
DWG / REFERENSI : NCR. NO :
ITEM / COMPONENT : DATE :

Fabrication Location ( Location of NCR )

Detail of NCR

Production / Site Inspector QC

Name Signature Date Name Signature Date

Action To Be Done ( Recommended Disposition )

Recommended By : Production / Site Inspector QC

Name Signature Date Name Signature Date

Authorized Disposition : Repair Reject Use as it

Reinspection Result :

Verified By : Signature Date Verified