Master Non-Conformance/Corrective - Preventative Action Report

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

1. Originator

• Name:

• Position:

• Report Type:

  Non-conformance/Corrective Action

  General Maintenance or Repairs/Preventative Action

  Technical Failure

• Technical Failure will only be used if there is a failure to a vital piece of equipment. This failure must pose a risk to health, safety or the environment. If this option is selected, Coast Guard 2692 Form must be filled out.

• Report Origin:

  Customer Feedback

  In-house

  Audit Finding

• Description of Non-conformance or Opportunity for Improvement request:

• Shore-based Manager:

• Response Date:

  Date

• Master's Name/Signature:

  Sign

• Date:

  Date

• Attach any photographs/relevant paperwork here.

  Media

• WHEN COMPLETE, SEND TO SHORE-BASED MANAGER (Steve Anderson)

2. Quality Assurance - Master Follow up

• Problems successfully addressed?

  Yes

  No

  N/A

• Notice to Proceed Granted?

  Yes

  No

  N/A

• Master's Name/Signature:

  Sign

• Date:

  Date

• When Quality Assurance check complete, email to Greg Bangert.