V-F-07a Contractor Non-conformance Report

• Site conducted

  Select

VERDIA TO COMPLETE

• Contractor Name

• Contractor's Representative

• Verdia's Representative

• Client Name

• Client Site

• Date NC occurred

  Date

• Date NC lodged

  Date

To be completed by Verdia within 1 week of Non-conformance date

• Type of non-conformance

  Select Safety Incident Workplace Hazard Legal Breach Unsatisfactory goods or service standards Financial Issue Other (please specify)

  • Safety Incident
  • Workplace Hazard
  • Legal Breach
  • Unsatisfactory goods or service standards
  • Financial Issue
  • Other (please specify)

• Description of complaint:

• Photos

  Media

CONTRACTOR TO RETURN TO VERDIA WITHIN 1 WEEKS OF NON-CONFORMANCE

• Corrective action taken to deal with the effect of the NC (IMMEDIATE ACTION):

• Photos

  Media

• Corrective action taken to deal with cause (Involves a change in process/procedure):

• Photos

  Media

TO BE COMPLETED BY VERDIA

• Further Actions required

Action

• Action required

• Action complete?

  Yes

  No

  N/A

• Status

  Approved

  No Go

• Approved by Verdia Representative

  Sign