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Nonconformity Report Template

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NONCONFORMITY REPORT 017-F004-2667

Contract No.: T9 / P18 / 004 NCR No.: 2015 - 0001


Procurement and Construction for the Proposed New LNG Jetty
Project Name: (Berth 4) at Bintulu Port, Malaysia Project No.: 2667
NCR Location:       Date:      

1. DESCRIPTION OF NONCONFORMANCE
     
     
Nonconformance detected by: SYS-MCD JV Owner’s Representative Other:      

Cause of Nonconformance: Material Failure Construction Method


Machine Failure Design Problem :
Relevant Documents:      
     
     
2. IMMEDIATE ACTION TO RECTIFY THE WORK
Proposed Action:      
     
     
Contractor’ Position:       Date: __________
s Signature:
Owner’s Representative Approval Date:      
(if required)
Comments (use additional page as necessary):      
     
     
Rectification work has been completed satisfactorily: Initial:       Date:       Completed

Owner’s Representative       Date:      


Approval:

3. IMMEDIATE CORRECTIVE ACTION TO PREVENT RECURRENCE


Proposed Action:      
     
     
Contractor’ Position:       Date:      
s
Signature:

Corrective Action has been carried out satisfactorily: Initial:       Date:       Completed

Owner’s Representative       Date:      


Approval:

017-F004-2667 Rev1 15Jun2015 Page 1 of 2


NONCONFORMITY REPORT 017-F004-2667

4. ADDITIONAL ACTIONS
Are there any additional actions required to address the underlying cause of the noncompliance?
Yes No
If yes, raise an Improvement Notification Report (Document # 010-F001-010) and issue to the Quality, Safety,
Environment Manager with a copy of this report.

5. NCR COST ESTIMATE VALUE (CURRENCY __ )


ITEM DETAILS VALUE (CURRENCY __ )
Material Cost
Labour Cost
Equipment Cost
Other
TOTAL

017-F004-2667 Rev1 15Jun2015 Page 2 of 2

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