Project NCR No.

:
NONCONFORMANCE REPORT
Rev. No.:

●INTERNAL
Business Owner: Air Liquide Arabia ( ALAR)
Distribution List: n/a

PROJECT NAME (if applicable) PROJECT N° (if applicable)

PROCESS (for non-project NCR)

EQUIPMENT (if applicable) PIPELINE ITEM/TAG (if applicable)
SUPPLIER/SUB-SUPPLIER/CONTRACTOR/SUB-CONTRACTOR NAME: HKSS PURCHASED ORDER N°:
2a. NC ISSUER NAME: POSITION: DATE:

2b.SUSPECTED CAUSE OF NC
(Issuer to provide)

2c. LEADER FOR NC CORRECTION

NAME POSITION:
(curative action)

3. PHASE WHERE NC WAS IDENTIFIED: ERECTION PROVIDE DETAILS OF OTHER:

4. NONCONFORMANCE DESCRIPTION (specification or reference of relevant document to be included) (section to be completed by the issuer)

5. CORRECTION IMPACTED PHASES/

(section to be completed with the support of disciplines experts if necessary ) - (Details of impacts to be precise if needed)
DISCIPLINES
Machines: -
Pressure Vessels: -
Piping/Installation: -
Design
Civil Work/Structures: -
Instrumentation: -
Electricity: -
Purchasing/Inspection/QC: N/A
Procurement
Logistic: N/A
Fabrication/Erection: YES
Construction Work
Commissioning: NO
Other Specify: N/A

6.NON-CONFORMITY RANKING (Details of impacts to be precise if needed)

Incidence HSE:
Incidence Equipment Integrity:

Recurrent Issue
Critical
(may be recurring major issue)

Jeopardizes Commercial
Start-Up
Incidence performances/reliabil.:
Incidence regulation:
Major Incidence cost/schedule:

Recurrent Issue
(may be recurring minor issue)
Incidence Customer Satisfaction
Minor (If none of the above cases are selected, consider that the nonconformity might be minor)
Technical Comm. N/A

7. TECHNICAL REVIEW REQUIRED FOR CORRECTION Design Authority N/A

(Technical issue requiring Technical Committee or Design Authority review) Third Party N/A
Regulatory Authority N/A
8. ACTIONS RECOMMENDATIONS (section to be completed by the issuer)

Source target response date: (on actions to correct conditions & recommend other solutions)
9. ACTIONS TO CORRECT CONDITION (Curative) (To be completed by contractor/supplier) LEADER DEADLINE EFFICIENCY

10.COMMONALITY (other items, other ongoing/current projects which may have the same issue)
 section to be completed by the Quality Representative taking into account guidance
Select
11. DECISION ON ACTIONS from CCQ or experts/Design Authorities/Technical Committee (as applicable) and
Decision on Action
third party validation (if required)

Name: Position: Signature: Date:

12a. ROOT CAUSE (Mandatory for Critical or Major NCR_Fault Tree Analysis or other recognized methodology mandatory for critical NCR or as deemed necessary by the Quality Rep.)

12b. CORRECTIVE ACTION IMPACTED

(section to be completed with the support of disciplines experts if necessary ) - (Details of impacts to be precise if needed)
PHASES/DISCIPLINES
Machines: N/A
Pressure Vessels: N/A
Piping/Installation: N/A
Design
Civil Work/Structures: N/A
Instrumentation: N/A
Electricity: N/A
Purchasing/Inspection/QC: N/A
Procurement
Logistic: N/A
Fabrication/Erection: YES
Construction Work
Commissioning: N/A
Other Specify:

13. CORRECTIVE ACTIONS (To be completed by contractor) LEADER DEADLINE PROGRESS % CLOSE OUT DATE

RESPONSIBLE
14. ACTIONS TO PREVENT RECURRENCE (MUST BE LINKED TO CAPITALIZATION) DEADLINE REMARKS
INDIVIDUAL
(to be added within Project Risk Identification Checklist)
(Lessons Learnt to be updated )
(procedure to be updated)
(Control Point to be added within Inspection Data Sheet template)

15. DECISION ON PROPOSED CORRECTIVE ACTIONS (section to be completed by the Quality Representative)

Name: Position: Signature: Date:

Comments/Conditions to be implemented (if ACCEPTED with Conditions) Reasons of rejection (if REJECTED)

16. DISTRIBUTION OF CLOSED NCR

Name: Name/Company:
Name: Name/Company:
Name: Name/Company:
ATTACHEMENTS:

History of updates
Rev Date Description