COMPONY LOGO COMPONY

NAME
(PROJECT)

NON- CONFORMITY REPORT(NCR)

FORM NO:
NCR No.: Rev.:

Originator: Discipline: QC Date:

Non-Compliance with (Specification, Procedure...)

Description of Non-Conformance:

Proposed Corrective Action:

Proposed Preventive Action:

Disposition : Rework Repair Use as is Scrap

Discipline Man. QA/QC Man. TP Company Rep.

A
Name: Name: Name: Name:

Sign: Sign: Sign: Sign:

Date: Date: Date: Date:

NCR Closing Evaluation:

Discipline Man. QA/QC Man. TP Company Rep.

A
Name: Name: Name: Name:

Sign: Sign: Sign: Sign:

Date: Date: Date: Date: