Logo here SAFETY NON-CONFORMITY Document number here

fjcabagte@gmail.com REPORT
SECTION I Project: Date:
…………………………………………………………………………… …………………………….
Issued To :  CabagteQHSE & Construction Co. Ltd.  SUBCONTRACTOR SNCR No:

Date: …………………………. Time: …………………… Hrs Location: …………………………………………

Description of Non Conformity:

SECTION II - INVESTIGATION OF THE ROOT CAUSE OF NON-CONFORMITY

SECTION III – CORRECTION & CORRECTIVE ACTIONS: (Attach pages if necessary)

Proposed By :- Head of department

Name: Name:

Signature: Date: Signature: Date:

Details of follow up inspections: Status

Date Time Results of follow–up inspection Pendin Cleared

SECTION IV – CLOSE OUT CabagteQHSE & Construction Co. Ltd.  SUBCONTRACTOR 

DATE NON-CONFORMITY CLEARED
Name: ……………………………………… Designation: ……………………… Signature:
……………………………
DATE Verified By:   Subcontractors
Name: …………………………………… Designation: ………………………… Signature:
……………………………

LOST TIME Days: Man hours: Comment

s:
(Time lost due to suspension of work, analysis of non-conformity, implementation of corrective & preventive action

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