QAC.822.MAN.F.001.

A
QUALITY & SERVICE AUDIT Page 1 of 1
Revisi : 02
NON-CONFORMANCE REPORT
Tanggal : 03 Nopember 2016

Auditor : Date :
Auditee : Outlet :
Store In Charge : Shift / Jam :
KETIDAK SESUAIAN / POTENSI KETIDAKSESUAIAN Sign
(NON – CONFORMANCE FINDING) :

Auditee

Auditor
ANALISA PENYEBAB (PROBLEM IDENTIFICATION) :

Date :
RENCANA TINDAKAN PERBAIKAN & PENCEGAHAN
(CORRECTIVE AND PREVENTIVE ACTION) : Prepared by

Store In Charge
End Date :

Approved by

Area Manager
CATATAN PELAKSANAAN TINDAKAN PERBAIKAN &
PENCEGAHAN (REMARKS FOR CORRECTIVE AND PREPENTIVE
Verified by
ACTION) :
• Closed • Re – Verified Area Manager Tanggal :

• Closed • Repeat / Unclosed Auditor Tanggal :