NON
CONFORMANC
E REPORT
Location Name Contractor Company Designer Company
Originated By:
Name Signature Date
Designation Organization
Received by:
Name Signature Date
Designation Organization
Contractor Revision
Reference
Name Signature C1 C2 C3 DD MM YY HH MM
Received by ER NCR
CODE-1 CODE-1 CODE-1 CODE-2 CODE-3
S1 to S21 D1 to S3 Kp XXX Work Activity Sub Element of Activity
Station Reference Depot Reference For Kilometer point only
Section 1: Description of Deficiencies / Non-conformity:
Location of Finding Date of
NCR
Subject
NC is noted against the following topic(s) with evidence attached:
Specification Drawing Method ITP Other
NC Reference Clause(s):
Section 2: Description of Deficiencies / Non-conformity:
Section 3: NCR Closure
Proposed corrective / preventive action has been checked and approved and implemented as per
Correction Proposal Request Form No:
Closure for Contractor Approved by:
Name Signature Designation Organization Date
Closure Accepted by:
Name Signature Designation Date
Employers
Representative
Distributed to: Employers Representative Originator Designer NAT
File Name: 927038562.docx Page 1 of 1