XYZ Company

Non Conforming Report

Date Found By
Area Section
1 Raw Material Name of goods
2 WIP Goods No
3 Finish Good Origin

Defect
Defect type Quantity of defect
no of inspected items

Disposition
1 Return to Supplier remark
2 Reject / scrap
3 Repair / Rework
4 Down grade
5 Concession

In case of Rework
Repair/ rework by Reverification by Result

In case of Concession
Customer concession no (if any)
Authorization by action

Date
1 concession is limited to batch/lot
2 From batch or lot no Up to lot no
others remark
XYZ company
Preventive dan Corrective Action request form CAR/PAR no
Date
Preventive Action Corrective Action

Description of Problem (attach scketch if necessary) applicability (please select)

1. Customer complain
2. Complain to Supplier
3. Action request for Machine
4. IQA, Safety Audit, Env Audit
5. Action request for NC product
Originator Acnowledgement Recepient Acnowledgement
Name Name

Section Section Section

Temporary Action Effective Date
Made By

Check By

Approve By

Root Cause Analysis Recommended Action

Effective date by
Verification
Originator QMR Recepient Verification date
Problem solve yes no
if no please explain

date
XYZ Company
Document Change Notice

Date
Document name
Reason of change originator
made by check by

Change
old new

current revision no new revision no

current date of release new date of release
In case of using this document for design change / product spec change

1 Starting lot no for new changes

2 Effective date of new changes
3 Effective date of new changes in production line
4 check by approve by

Authorization
change made by authorization Date

Checker
1. are old documents retrieved and disposed as procedures ?
2. are new document distributed and controlled ?
 ECR No Current rev no
Engineering Change Request Date New rev no

Reason for change s

1 Cost Down 5 Customer request
2 New Design 6 Request from Manufacturing
3 New Technology 7 Others
4 Localization

Detail of changes
Component
Assy
Process
Vendors
Packing
Other
Description
Current New

Effective date
Date
Manufacturing lot no
Approval Customer Approval (if required) Product / Part Approval
Made by Approve by Submission Required / No

Check By Plant PPAP level

Approve by Phone Remark

Approval date Approval Date

XYZ company
Training Need Analysis

No Section Name Position Apprisal result comment

His weakpoint is on
1 maintenance Budiman Leader electrical matters
Training need

Electrical
XYZ Company
Approved Vendor List
Material Catagories
1. Raw Material 4. Support material
2. OutSourcing process 5. Spare part
3. Sub Material 6. others

Supplier categories
1. OEM (pemegang merk)
2. Agen Tunggal (authorized dealer)
3. Trading company
4. Pabrikan pemegang lisensi
5. Work shop berdasarkan job order
6. Anak perusahaan dengan dukungan principal dari luar negeri
7. Brooker, penghubung kepada lain party

no Company name Address Phone fax Email Contact Comodity

supplier categories principal