AVANTIS Form Name: Non-Conformance Report

Non-Conformance No: Revision No: Date:

Client Name: Client PO No: Supplier Name:

Project No: Document No: Drawing No: N/A

Item Description/ Tag No: Manufacturers SI. No: Qty Non-Conformed:

Part A:- Identification of Non-Conformance / Improvement

Description of Non-conformance etc; attach any background information or correspondence
Customer Complaint Internal NC Supplier Reject Third Party Improvement

Raised By: Date:

Part B - Disposition
Use As Is Rework/ Repair Scrap/ Replace Other (please specify)

Proposed By: Date:

Reviewed and
Date:
Accepted By:
Part C – Corrections (To be completed as soon as possible after problem has been raised)
Action: Responsible: Planned Completion Date:

Completed By: Date:

Reviewed and
Date:
Accepted By:
Part D – Investigation & Root Cause Analysis– State Root Cause Analysis Tool Used (ie 5 Whys)

Completed By: Date:

Reviewed and
Date:
Accepted By:
Part E – Corrective/ Preventive Actions
Action: Responsible: Planned Completion Date:

Completed By: Date:

Reviewed and
Date:
Accepted By:
Part F - Effectiveness of Corrections & Corrective/ Preventive Actions
Action: Responsible: Planned Completion Date:

Effectiveness of
Date:
Action verified by:

AV-NC-F01 Issue 1 September 2019