Section 1
To be Completed by QA DEPT.
Non Conformance Description:
Quantity:
QA/QC
Date:
Disposition?
Section 2 (To be completed by Receiver)
Please reply or return fax asap
Cause Analysis
Corrective Action
Name and Signature
Date
Section 3 (To be completed by QA dept)
Remedial Results?
Remarks
QA Name and Signature
Date: