1. NCR No.

Nonconformance Report
Ames Research Center
Identify Nonconformance
NCR
Origi 2. Originator: Phone: Date: Org:
nator

3. Item Name: Qty:

4. Dwg / Part No: 5. Found During
Lot / Serial No: What Activity:

6. Item Location:
7. Actual Condition:

8. Req’d Condition:

Disposition Nonconformance
Resp 9. Authorized _ 10. Disposition Rationale:
onsib Disposition:
le _ Scrap
Mana
_ Return to
ger/R
Supplier
eview
Team _ Repair
_ Regrade
_ Use As Is
11. Cause Classification: _ Design _ Manufacturing
_ Supplier _ Training
_ Other (explain)________________________________________

12. Responsible Manager: Signature: Date:

13. _ Request Waiver (ARC 762) Waiver No:

(Procedure 53.ARC.0013.1)
14. Disposition Details:

15. Corrective Action Req’d _ 16. CAR No:

Yes
(Procedure 53.ARC.0014) _ No

Rationale (if
yes):
17. Safety Function:
(If Safety Is Affected) Signature: Date:

ARC 758 (9/98) E

 Disposition Nonconformance
Re
s . 18. NCR Closed By: Signature: Date:
M
gr.

NCR No.
Nonconformance Report
Ames Research Center

ARC 758 (9/98) E

 Page of

Continuation Page

ARC 758 (9/98) E