NON-CONFORMANCE REPORT (NCR)

PART A DETAILS
NCR NO: HSSI(PDMO)/CVIA(P1)-0036/22 PACKAGE/LOCATION: CVIA PHASE 1
ISSUED TO: MTD CONSTRUCTION NAME OF IDENTIFIER: DESMOND DATE ISSUED: 15 AUGUST 2022
SDN BHD PEREIRA
REFERENCE DOCUMENTS:
1. OSHA 1994
2. FMA 1967
3. EQA 1974
PART B NON-CONFORMITY STATEMENT
1. Lifting activity without full time supervision by lifting supervisor, worker standing in the lifting radius, lifting
radius without barricade and signages.
2. No updated lifting permit with the crane operator/ on site. Last lifting permit with the operator is June 2022.
3. Tagline tied to the wire rope and not to the load.

Reply Due Date: 19 August 2022 Attachment(s): Record Photo

Estimated Non-Conformance Value: Issued by: Confirmed by: Received by:

RM ______________
PD HSSI Contractor
PART C PROPOSED CORRECTIVE ACTION (to be completed by the Contractor)
CAUSE OF NON-CONFORMITY

IMMEDIATE ACTION

Target Date for Completion:

LONG TERM CORRECTIVE ACTION

Target Date for Completion:

Action by: Agreed by: Verified by:

Contractor Identifier PD HSSI

PART D VERIFICATION OF CORRECTIVE ACTION
FOLLOW-UP REPORT

NCR Closed Out? Complied by: Verified by: Approved by:

YES - Date:
NO - Next completion date:
Contractor Identifier PD HSSI
 PICTURE ATTACHMENTS

Lifting activity without full time supervision by lifting supervisor, worker standing in
the lifting radius, lifting radius without barricade and signages.

No updated lifting permit with the crane operator/ on site. Last lifting permit with
the operator is June 2022.

Tagline tied to the wire rope and not to the load.