Non-conformance Report

Doc. No. : VIPL/QC/NC/22/10-01

IDENTIFICATION
1. Originator Name : 2. Date :
3. Department : 4. NC No : DD/MM/Shift -No.

5. Product Name/Type : 6. Quantity :

7. Product Description : 8. Batch No :
9. Shift and Time : 10. Machine No :

11. Found during what activity :

Final inspection Others

Incoming inspection In process inspection

12. Description of non-conformance (use continuation page if necessary)

Cutter Man: Operator: Supervisor :

13. Route Cause (use continuation page if necessary)

Production Supervisor

DISPOSITION
14.
Use as is Return to supplier
Production Incharge
Repair Reject Name:
Reprocessing Date: Sign. :
Justification if use as is /Repair:

15. Approval Quality Incharge

Non critical NC Name : Sign.
Critical NC Date :

CORRECTIVE/PREVENTIVE ACTION
16. Description of proposed action (use continuation page if necessary)

Quality Head: Production Head/Manager:

Date Sign : Date Sign:

CLOSING THE NON CONFORMANCE

17. Planned disposition has been completed and corrective/preventive action has been initiated
Responsible Manager Sign Date: