Non Conformance Report Form
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P.O.S. DIVISION
NON-CONFORMING REPORT NCR NO...................... SUPPLIER:................................................ DESCRIPTION............................................................. CUSTOMER/ DEPARTMENT ............................................................. NATURE OF NON-CONFORMANCE
ORIGINATOR...............................................................DATE......................................................... REPORTED TO:........................................................... POSITION:................................................ SIGNATURE:.................................................................................................................................... ROOT CAUSE: ________________________________________________________________
SIGNED:........................................................................ POSITION................................................ CORRECTIVE AND PREVENTIVE ACTION TAKEN: _______________________________
SIGNED:..........................................................................POSITION:.............................................. MANAGEMENT REPRESENTATIVE’S COMMENTS:
SIGNED......................................................POSITION..............................DATE............................ FOLLOW UP ACTION REQUIRED?
YES.........................NO.........................
FOLLOW UP ACTION TO BE TAKEN BY:.................................................................................. FOLLOW UP ACTION TAKEN:__________________________________________________
SIGNED:............................................................................DATE:.................................................... ESTIMATED COST:
NON-CONFORMING REPORT NCR NO...................... SUPPLIER:................................................ DESCRIPTION............................................................. CUSTOMER/ DEPARTMENT ............................................................. NATURE OF NON-CONFORMANCE
ORIGINATOR...............................................................DATE......................................................... REPORTED TO:........................................................... POSITION:................................................ SIGNATURE:.................................................................................................................................... ROOT CAUSE: ________________________________________________________________
SIGNED:........................................................................ POSITION................................................ CORRECTIVE AND PREVENTIVE ACTION TAKEN: _______________________________
SIGNED:..........................................................................POSITION:.............................................. MANAGEMENT REPRESENTATIVE’S COMMENTS:
SIGNED......................................................POSITION..............................DATE............................ FOLLOW UP ACTION REQUIRED?
YES.........................NO.........................
FOLLOW UP ACTION TO BE TAKEN BY:.................................................................................. FOLLOW UP ACTION TAKEN:__________________________________________________
SIGNED:............................................................................DATE:.................................................... ESTIMATED COST:
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