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QIDDIYA INVESTMENT COMPANY

DOCUMENT NUMBER: QDC-ADM-TEM-QMS-00014 REVISION NUMBER: 0B ISSUED BY: PMO


DOCUMENT TITLE SITE OBSERVATION FORM DOCUMENT TYPE: FORM DATE ISSUED: JUNE 2, 2022
PROJECT INFORMATION
DATE OF ISSUE S.O# CATEGORY VAF ( Violation After the Fact)
PROJECT TITLE CN# CONTRACTOR

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

REFERENCES
1. DESCRIPTION OF SITE OBSERVATION

Photo 1 (Click to Insert Photo) Photo 2 (Click to Insert Photo)

Photo 1 Photo 2
Description Descitption

*Additional Photo's can be attached as supplemental documents.


AGREED COMPLETION DATE TITLE Name Signature Date
(ACD) Supervision Consultant (initiator)
Contractor to Acknowledge the S.O and responsd with the Acknoledgement withing Seven (7) Days
Contractor Quality Engineer / Inspector
Contractor Quality Manager
*FAILURE TO RESOLVE DEFICIENCIES ABOVE AFTER (ACD) WILL RESULT IN ESCALATION TO NEXT LEVEL AS PER QDC QUALITY PROCEDURE

CONTRACTOR TO LIST THE PROSPOSED CORRECTIONS TO BE IMNPLEMENTED (* Not Required for PAN)
2. PROPOSED CORRECTIONS

RECEIVER SHALL LIST THE ROOT CAUSE THAT LEAD TO THE OCCURANCE OF DEFICIENCY (* Not Required for PAN)
3. ROOT CAUSE

CONTRACTOR TO LIST THE CORRECTIVE/PREVENTIVE ACTIONS THAT HAVE BEEN IMPLEMENTED (*Optional for PAN)
4. CORRECTIVE / PREVENTIVE ACTIONS

S.O ORIGINATOR SHALL REVIEW THE IMPLEMENTED CORRECTIONS (* FOR PAN notifications, Contractor Acknowledgement is only required)

Implemented correction and corrective/ preventive action(s) were found to be satisfactory & this S.O 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 S.O is considered opened.
5. REVIEW AND CLOSURE

Corrections were not completed by the ACD date and has been escalated to next level as per QDC Non-CONFORMANCE escalation procedures.

REMARKS

NAME DESIGNATION

ORGANIZATION DATE SIGNATURE

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

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