NON-CONFORMANCE REPORT (NCR)
1. NCR Number:
(Unique identification number for traceability)
2. Date of Report:
(Date the NCR is created)
3. Reported by:
(Name of the person reporting the non-conformance)
4. Department:
(Relevant department or team)
5. Equipment/Item Description:
(Brief description of the flame arrester or equipment involved, including model
number and serial number)
6. Non-Conformance Details:
6.1. Non-Conformance Type:
Design
Material
Manufacturing Process
Documentation
Inspection
Testing
Shipping
Other (please specify): ____________________
6.2. Non-Conformance Code:
(Reference to applicable codes like IECEx, ATEX, or ISO standards)
(Example: IECEx XX, ISO 9001:2015 Clause 8, ATEX 94/9/EC)
6.3. Description of the Non-Conformance:
(Detailed description of the issue, including measurements, deviations, or
discrepancies)
6.4. Location of Non-Conformance (if applicable):
Internal Manufacturing
Testing
Inspection
Packaging
Shipment
Other (please specify): ____________________
7. Impact Assessment:
7.1. Potential Safety Impact:
Fire Hazard
Explosion Hazard
Electrical Hazard
Mechanical Failure
Other (please specify): ____________________
7.2. Compliance Impact:
IECEx Compliance
ATEX Certification
ISO 9001 Compliance
Other (please specify): ____________________
7.3. Urgency:
Critical
High
Medium
Low
8. Root Cause Analysis:
8.1. Immediate Cause of the Non-Conformance:
(Initial thoughts on what directly led to the non-conformance)
8.2. Underlying Cause:
(Further analysis into systemic or recurring issues)
8.3. Contributing Factors:
(Factors such as training, equipment malfunction, design errors, etc.)
9. Corrective and Preventive Actions:
9.1. Corrective Action Plan:
(Actions required to address the specific non-conformance)
9.2. Responsible Person(s):
(Who is responsible for implementing corrective actions?)
9.3. Due Date for Corrective Action Completion:
(Date by which corrective actions should be completed)
9.4. Preventive Action Plan (if necessary):
(Actions taken to prevent recurrence of this non-conformance)
9.5. Effectiveness Review:
(Plan for reviewing if corrective actions were successful, including testing/validation)
10. Verification and Validation:
10.1. Date of Verification:
(Date when corrective actions were verified)
10.2. Verified by:
(Name of the person verifying the corrective actions)
10.3. Validation Method:
Inspection
Testing
Certification
Other (please specify): ____________________
11. Documentation and Attachments:
11.1. Supporting Documents:
Test Reports
Inspection Records
Design Documents
Certifications (IECEx, ATEX, ISO)
Photos
Other (please specify): ____________________
12. Management Review:
12.1. Date of Review:
(Date of management review of NCR)
12.2. Management Comments:
(Any additional comments or instructions from the management team)
12.3. Approved by:
(Signature and Name of authorized reviewer)
13. NCR Closure:
13.1. Date Closed:
(Date when NCR is formally closed)
13.2. Closed by:
(Name of person who closed the NCR)
13.3. NCR Closure Comments:
(Any final comments regarding the closure of the NCR)
Signature & Approval:
Reporter’s Signature: ______________________
Date: ______________________
Supervisor’s Signature: ______________________
Date: ______________________
Quality Manager’s Signature: ______________________
Date: ______________________
