QIDDIYA INVESTMENT COMPANY

DOCUMENT NUMBER: QDC-ADM-TEM-QTY-00009 REVISION NUMBER: 0D ISSUED BY: PMO

DATE
DOCUMENT TITLE NON CONFORMANCE REPORT DOCUMENT TYPE: FORM 22-Jun-22
ISSUED:
PROJECT INFORMATION
DATE OF ISSUE NCR# CATEGORY Qiddiya NCR
PROJECT TITLE CN# CONTRACTOR

DESCRIPTION *(ISSUER shall keep the Description to the point. If Filling by hand, use clear open letter handwriting)
1. DESCRIPTION OF DEFICIENCIES

REFERENCES
TITLE Name Signature Date
AGREED COMPLETION DATE
Supervision Consultant (initiator)
(ACD) Qiddiya Quality Representative (For DNCR)
Qiddiya Project Representative (For DNCR)
Contractor to Acknowledge the QNCR and response with the Acknoledgment withing 48 Hours
Contractor Quality Manager
Contractor Project Manager
*FAILURE TO RESOLVE DEFICIENCIES ABOVE AFTER (EACD) WILL RESULT IN ESCALATION TO NEXT LEVEL AS PER QDC QUALITY PROCEDURE
RECEIVER SHALL LIST THE PROPOSED CORRECTIONS TO BE CARRIED OUT
CORRECTION(S)
2. PROPOSED

RECEIVER SHALL LIST THE ROOT CAUSE THAT LEAD TO THE OCCURANCE OF DEFICIENCY
3. ROOT CAUSE

RECEIVER SHALL LIST THE CORRECTIVE /PREVENTIVE ACTIONS TO AVOID DEFICIENCY FROM RE-OCCURING
4. CORRECTIVE/PREVENTIVE
MEASURES

NCR ORIGINATOR SHALL REVIEW THE IMPLEMENTED CORRECTION, CORRECTIVE/ PREVENTIVE ACTIONS(S)

Implemented correction and corrective/ preventive action(s) were found to be satisfactory & this NCR is considered closed.

Implemented correction and corrective/ preventive action(s) were found to be not satisfactory. Works have to be redone as per the approved proposal. This NCR is
considered opened.
Justification Accepted to Extend Extended
5. REVIEW AND CLOSURE

Cotractor Submitted Justification to EXTEND ACD.

Justification No Accepted ACD
Implemented correction and corrective/ preventive action(s) were not completed by the EACD date and has been escalated to next level as per QDC Quality
procedures.

REMARKS

NAME DESIGNATION

ORGANIZATION DATE SIGNATURE

ORIGINATOR RECIPIENT
DISTRIBUTION
OTHER (Specify:_________________________) OTHER (Specify:_________________________)
This Document is the Property of Qiddiya, 2021