NON CONFORMANCE REPORT

PART- A : TO BE COMPLETED BY AUDITOR

From Manager - Audit & Surveillance
Audit # B003/8 NCR # 01/01 To Manager-Line Maintenance
Level II Previous NCR N/A Company / CVR Readout Facility
(Refer Note) Ref. (If Any) Department /
Aircraft
Risk Index S2-L4
(Refer Note)
Date of Audit 17-04-2017 Place of Audit Chennai
Area of Audit Preservation and retention of records Response Date 20-05-2017
Reference:
LMM Vol I 2.40.3 CVR Readout Procedure
(b) The relevant records will be preserved in the CVR readout facility for a period of 3 years in case of incidents /
accidents only.
Finding:
Records of incident /accident cases are retained only for the year 2016 and 2017, whereas relevant records are to
be preserved in the CVR readout facility for a period of 3 years in case of incidents / accidents only.

Issued by Anand Athalye Date 21-04-2017

PART-B : TO BE COMPLETED BY AUDITEE (Please refer “NOTES” for completion and returning the NCR)
Possible Root Cause:
Man Measurement Machine Method Material Environment Others (Specify)
Root Cause :

Corrective Action :

Target Date Completion Date

Preventive Action :

Target Date Completion Date

Name of Manager-in-charge Signature

Position Date
PART-C: TO BE COMPLETED BY AUDITOR

DOC NO: JA/E&M/EQ/41 PAGE 1 OF 2 REV - 5.0 / 07 MAY 2015

 NON CONFORMANCE REPORT

Check (x) the applicable box.

This NCR has been reviewed as stated below :

Corrective action : Satisfactory Not Satisfactory Additional information required
Preventive action : Satisfactory Not satisfactory Additional information required
Name Signature Date
PART-D : TO BE COMPLETED BY MANAGER-SURVEILLANCE & AUDIT

This NCR has been verified as stated below:

Satisfactory Unsatisfactory

NCR closed New NCR issued Ref. No.

Name Signature Date

NOTES
Significant non-compliance with regulatory requirements which lowers the safety
Level I
standard and hazards seriously the flight safety.
Non-compliance with regulatory requirements which could lower the safety
Level II
standard and possibly hazard the flight safety.
Risk Index Risk Index must be determined as per Safety Management System.
1. Possible Root Cause: - Tick the appropriate box and describe the root
cause.

2. Corrective and Preventive Action:

(a) The details of completed Corrective and Preventive action along
Completion of NCR by
with supporting evidence must be provided within the “Response date”.
Auditee
(b) If corrective/ preventive action is not feasible within the “Response
date” then the “Target date” must be provided with proper justification.

3. The duly completed NCR must be returned within the response date, to
the auditor via official email.

DOC NO: JA/E&M/EQ/41 PAGE 2 OF 2 REV - 5.0 / 07 MAY 2015