[Company Name]

[Company Group, Division, Location]

Internal Audit Non Conformance Record

NON CONFORMANCE DATA
AREA/ACTIVITY AUDITED RESPONSIBLE SUPERVISOR/MANAGER NCR NO. DATE
  /  /  
STANDARD/PROCEDURE REFERENCE

INSPECTION LEVEL INCOMING IN PROCESS FINAL

ITEM PO/ DRAWING/ SPEC. DESCRIPTION OF NON CONFORMANCE DEFECT CODE

MGR/SUPERVISOR NAME SIGNATURE DATE

  /  /  
AUDITOR NAME SIGNATURE DATE
  /  /  
DISPOSITION
ITEM DISP. CODE INSTRUCTIONS/ COMMENTS

DISAPPROVED
REASON FOR DISAPPROVAL:

APPROVED DUE DATE

INSTRUCTIONS:   /  /  

CLOSEOUT
RE-INSPECTION IR NO. CORRECTIVE ACTION CAR NO. NOTIFY SUPPLIER DUE DATE
YES NO YES NO YES NO   /  /  
ORIGINATOR NAME SIGNATURE DATE
  /  /  

Form No. _____ Rev No. _____