Company: _________________________________________

NON CONFORMANCE / CORRECTIVE ACTION REPORT

CUSTOMER : LOCATION
3

PROCESS

NCR NO.

DEPARTMENT :
3

DESPOSITION CODE : :

VENDOR / SUPPLIER : MAJOR

PURCHASE ORDER NO.

MINOR

HSE & QUALITY SYSTEM COMPLIANCE : NO DATE : ...

CUSTOMER COMPLAINT : YES DESCRIPTION OF NON-CONFORMANCE :

REPORTED BY :

POSITION : .

SIGN :

CORRECTIVE ACTION OR DISPOSITION :

( Action must include cause, analysis, corrective action taken and action to pervent reoccurrence )

IMPLEMENTATION DATE : SIGN : . POSITION : DATE : ..

PROPOSED ACTION TO BE AGREED OR REJECTED BY DIVISION MANAGER / HSEQ MANAGER: Proposed Action : Accepted Rejected

If Rejected Reason for Rejection and alternate Action Required :

SIGN : ... CLOSED OUT. DIVISION MANAGER :

POSITION : . SIGN : SIGN :

DATE : DATE : . DATE : .

CLOSED OUT. HSE & QUALITY MANAGER :

1 2 3

To be filled in by Quality Department. Disposition Code : ARework / Repair BAccept / Use-as-is CScrap D-Return to vendor E Regrade F-Customer Concession required. Ignore if not applicable.

Rev. 1 F 439 01-07-2003