Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
1. Shore-based Manager - Proposed Action
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For Corrective/Preventative Actions, please indicate:
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Root Cause of Problem:
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Proposed Corrective/Preventative Action:
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Proposed Completion Date
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Date Action Requested:
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Shore-Based Manager's Name/Signature:
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Date:
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IF THERE IS A NON-CONFORMITY, REPORT IT TO THIRD PARTY ORGANIZATION
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Notice to Proceed Granted by TPO?
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SEND BACK TO MASTER/GREG BANGERT FOR QUALITY ASSURANCE FOLLOW UP