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‫‪Issue No.

: 5‬‬
‫‪Identification of Nonconformity‬‬
‫‪Revision No: 1‬‬
‫‪F01P01.09.Q‬‬ ‫‪Issue date: Feb 2019‬‬

‫ﻧﻮع اﻟﻤﺸﻜﻠﺔ )ﻓﻨﻲ‪ /‬اداري(‪.............:‬‬ ‫اﻟﻤﻜﺎن‪..............................:‬‬ ‫اﻟﺘﺎرﯾﺦ‪..................................:‬‬

‫ﻣﺼﺪر اﻟﻤﺸﻜﻠﺔ‪:‬‬

‫[ ﺷﻜﻮي‪ /‬ﺗﻘﯿﯿﻢ ﻣﻦ ﻋﻤﯿﻞ‬ ‫]‬ ‫[ زﯾﺎرة ﻣﺘﺎﺑﻌﺔ ﻟﺘﻘﯿﯿﻢ اﻷداء‬ ‫]‬ ‫[ ﻣﻼﺣﻈﺔ أﺛﻨﺎء اﻟﻌﻤﻞ‬ ‫]‬
‫‪Acc. No:‬‬ ‫اﺳﻢ اﻟﻌﻤﯿﻞ‪ /‬اﻟﻤﺮﯾﺾ‪:‬‬
‫رﻗﻢ اﻟﺸﻜﻮى‪:‬‬ ‫رﻗﻢ اﻟﻌﻤﯿﻞ‪:‬‬
‫وﺻﻒ اﻟﻤﺸﻜﻠﺔ‪:‬‬

‫اﻟﺮد اﻟﺴﺮﯾﻊ‪:‬‬

‫رد اﻟﻮﺣﺪة‪ /‬اﻟﻔﺮع‪:‬‬

‫اﺳﻢ اﻟﻤﺴﺆول‪:‬‬
‫رد اﻟﻮﺣﺪة‪ /‬اﻟﻔﺮع‪:‬‬

‫اﺳﻢ اﻟﻤﺴﺆول‪:‬‬
‫ﺗﺼﺪﯾﻖ إدارة اﻟﺠﻮدة ‪ /‬اﻟﺘﻮﺻﯿﺎت‪:‬‬

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