FOR ACTION BY
(Unit/Division/Dept.) : BI/JO/WO/Contract/ PO No.: Work Location: Log Book Entry Date: Project Title/Contractor/Vendor: Plant No./Equip. No. Standard/Procedure/Contract Violated : NCR No.: Last Inspection Date:
DEFICIENCY / VIOLATION
COMMENTS / RECOMMENDATION
(Originator comments/recommendations are optional)
ACTION REQUIRED BY
Date Date
Signature Signature
Date:
Tel. No.
Signature:
No
Signature
WORKSHEET ISSUED:
Yes
NCR File/BI-File/Vendor File
No
Worksheet No.:
Date :