NON-CONFORMANCE REPORT

PBS Number PA or TA Number Report Number

DBS Number
Section 1 To be completed by the Contractor
1 - Contract number and Item Number(s):
2 - Contract title:
3 - Contractor:
4 - Item identification:
5 - Requirement:

6 - Description of the non-conformance:

7 - Proposed remedial use as rework repair reject alt. use

action: is

8 - List of attachments:

9 - Proposed non-conformance category:

MINOR non-conformance
(Report to be sent to US ITER for information and remedial action implemented)
MAJOR non-conformance
(Remedial action to be implemented only after US ITER written acceptance)
Contractors Responsible Officer Contractors Quality Officer

Name Date Signature Nam Date Signature
e
Section 2 To be completed by US ITER

Technical Responsible Officer QA Responsible Officer

Decision: Comment:

Name Date Signature Name Date Signature
Chief Engineer: (Reviewer) Division Director (Reviewer)
Initials

Initials

Technical Project Officer (Reviewer) Procurement Manager (Reviewer)

Initials Initials

WBS Task Leader (Reviewer) QA ES&H Manager (Approver)

Initials Initials
Section 3 To be completed by ITER IO
IO Technical Responsible Officer IO QA Responsible Officer
Decision: Comments:

Name Date Signature Name Date Signature

Page 1 of 1 US ITER-7 R5 (9-2012)

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