MIC Construct

NON-CONFORMITY REPORT

Office/Country: Location:
NCR Number: Date of NCR:
Reported by: Issued to:
Source (Strike through) :

REQUIREMENT IN WHICH DEVIATION HAS OCCURRED

(Contract / Project Quality Plan / Project HSE Plan / Drawing / Inspection Report / Standard / Procedure / Manual / Instruction) Clause No:

DESCRIPTION OF NON-CONFORMANCE
.

ROOT CAUSE(S) OF NON-CONFORMANCE

Completed by:

PROPOSED CORRECTIVE ACTION

Proposed by:

Approved by (CM / CMR):

Target Completion Date:
Action to be undertaken by:

Corrective Action Taken Effectiveness of Correct Action Taken

Corrective Action Effective? Yes No

NCR CLOSE OUT

I confirm that the corrective action is effective in remedying the non-conformity and preventing re-occurrence:
Action Verified by: Position:

Verifier’s Signature: Date:

POST VERIFICATION ACTIVITIES

Ensure marked as closed on the NCR Register (CFW-QHSE-
NCR Register Status: Open Closed FMT-023).
Revision to Internal Audit If yes, update Internal Audit Schedule (CFW-QHSE-FMT-
Schedule Required?:
Yes No N/A 047).

THE CLOSED OUT COPY OF THIS NCR SHALL BE ADDED TO THE RELEVANT ENTRY IN THE NCR
REGISTER ALONG WITH ALL PERTINENT COMMUNICATIONS

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