Segment 3

INSERT LETTERHEAD HERE

NON-CONFORMANCE
REPORT(NCR)
NCR No.:
Date :
Project :
Contractor :
Description of the Work :

Reference documents :

DETAILS OF NON-CONFORMANCE:

Prepared by: Noted by: Approved for issuance by:

_______________________
ER’s Field Representative Project Manager ER’s AVP
ROOT CAUSE ANALYSIS:

PROPOSED CORRECTIVE ACTION:* PROPOSED PREVENTIVE ACTION:*

__________________________________________ __________________________________________
__________________________________________ __________________________________________
__________________________________________ __________________________________________
__________________________________________ __________________________________________
__________________________________________ __________________________________________
__________________________________________ __________________________________________
Target Date of Completion : Target Date of Completion :
*PLEASE USE ADDITIONAL SHEETS AS NECESSARY

Response Prepared by: Approved for implementation by: Accepted by:

__________________________ __________________________ __________________________

Field Representative Project Manager or PIC ER’s Project Manager

REINSPECTION REMARKS: DETERMINATION:

_______________________________________________________
ISSUE CLOSED
_______________________________________________________
_______________________________________________________
_______________________________________________________ SUBJECT TO
_______________________________________________________ REINSPECTION

Inspected by: Concurred by: Noted by:

__________________________ __________________________ __________________________

ER’s Field Representative ER”s Project Manager ER’s AVP