Nonconformance Form

(may be nonconforming service, a nonconforming product, or the need to report loss, damage, or unsuitability of customer property)

Issue at Hand

Describe what is wrong or the concern needing attention:
Type of Action Needed (disposition):
Put a check mark or X in the box that best describes the action to be taken for the issue identified. If the problems involve loss, damage or unsuitability of customer property, let management know so that they can tell the customer. With use-as-is, we should attach any approval received from the customer to this form or note the name of the customer’s approving authority on this form when it is verbal. / Describe what needs to happen to fix the situation at hand (correction) split.
Rework/Repair
Use-As-Is
Scrap (when a product is involved)
Other:______
Reporting lost, damaged or unsuitable customer property to the customer.
Authorized By:
(member of management, Management Rep, or the customer sign here to acknowledge quality signing this form or attaching an authorization or waiver)
Approval for
Rework or Repair Performed: (when rework or repair was the disposition):

Does This Nonconformance Need A Solution To Prevent Further Actual Or Potential Problems?

(if the answer is yes to any of the questions shown below, utilize the Process Improvement Form or any other corrective/preventive action system outlined in the Improvement Systems process to ensure we are “closing-the-loop” on issues identified)

Was this one incident severe (bad) enough to need a solution intended to prevent this problem from ever happening again? (Corrective Action)
Based on a review of past incidents, is this incident showing a recurring problem needing a solution to prevent this pattern of nonconformance from happening again in the future? (Corrective Action)
Was this one incident close enough to being severe (potentially bad) that a solution intended to prevent this problem from ever is deemed necessary? (Preventive Action)
Based on a review of past incidents, including this one we have just resolved, are there signs we should take some sort of action to prevent the issue at hand from requiring corrective action? (Preventive Action)

Revision: 3/3/2008

COD-FRM-011