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QM501FA - Nonconformance Report

This document is a quality management plan nonconformance report form used to document any nonconforming conditions found during a construction project. The form includes sections to identify the nonconformance including location and specification requirement in question. It also includes spaces to describe the issue, required actions, proposed disposition including rework or replace options, and approval signatures from quality assurance and the design engineer if needed. Once completed, it provides a record of the nonconformance, resolution, and verification that corrective actions were carried out.

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360 views1 page

QM501FA - Nonconformance Report

This document is a quality management plan nonconformance report form used to document any nonconforming conditions found during a construction project. The form includes sections to identify the nonconformance including location and specification requirement in question. It also includes spaces to describe the issue, required actions, proposed disposition including rework or replace options, and approval signatures from quality assurance and the design engineer if needed. Once completed, it provides a record of the nonconformance, resolution, and verification that corrective actions were carried out.

Uploaded by

Rio Handoko
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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XXXX Design-Build Project

S.P. XXXXX
QUALITY MANAGEMENT PLAN

{Contractor}
Form.: QM501FA

Rev. 0

{date}

Page 1 of 1

NONCONFORMANCE REPORT
1. NCR Control No.:

2. (Sub)Contractor/Supplier:

5. Location:

3. Originator & Organization:

6. Originator:

4. Date:

7. Specification Section & Drawing No.:

8. Contract Requirement:

9. Nonconformance Description:

10. NCR Required?: Yes


No
11. Reply requested from:
______________________________________
Quality Assurance Signature
13. Root cause of the problem and action(s) to prevent recurrence:

12. Need Date:

14. Proposed Action(s):

15. Disposition status:

Reject Work

Rework

Repair

Revise

Replace

Redo

17. Disposition Prepared By:

Signature

Use-As-Is

16. Notice of Design Change


Required?
Yes
No

18. Design Engineer Approval: (for Construction Repair and Use-As-Is status)

Date

Print Name

Signature

Date

Concurrence of Corrective and Preventive Actions:


19.

Originator

Date

20.

Quality Assurance Signature

Date

21. Mn/DOT has reviewed the above and accepts the NCR proposed disposition and/or corrective measures.
Print Name

Signature

Date

22. Quality Manager verification that nonconforming condition has been corrected:
Verified By:
Print Name

Signature

MnDOT Design-Build Quality Template (June, 2011)

Date

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