hs non conformance report form

ATC South Africa Approval Date: 2012/03/20 Document number: HSE-FRM-0020 Title: Non-Conformance Report Form Rev: 2 Owner: Limpho Matolo Page 1 of 1 y y y y m m d d Detail on what happened during the site visit y y y y m m d d Yes No y y y y m m d d ATC (Close Out Remarks) y y y y m m d d Preventative Action Close Out Re-issue Other Follow-up on action and result Low Reference Act Plan Investigation Findings (attach photos to substantiate the findings ) / Attach on next page High Medium Issued by Date Non-Conformance Description Immediate Actions / Instructions, including Corrective Measures taken Time Actual / Potential Deficiency - Risk Rating Quality Purpose of Site Visit Audit Inspection Investigation Neotel Internet Solution Non-Conformance Report Form Identification Vodacom ATC Employee Reporting Location / Site Name Customers Date Non-Conformance Classification Safety Health Environment Site Number Cell C MTN iBurst Basillius Comsol Debarko 8ta Responsible Person Date Proposed Corrective Action Responsible Customer Due Date Action sufficient?

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ATC South Africa Approval Date: 2012/03/20

Document number: HSE-FRM-0020Title: Non-Conformance Report Form Rev: 2

Owner: Limpho MatoloPage 1 of 1

y y y y m m d d

Detail on what happened during the site visit

y y y y m m d d

Yes No

y y y y m m d d

ATC (Close Out Remarks)

y y y y m m d d

Preventative Action

Close Out Re-issue Other

Follow-up on action and result

Low

Reference Act Plan

Investigation Findings (attach photos to substantiate the findings ) / Attach on next page

High Medium

Issued by Date

Non-Conformance Description

Immediate Actions / Instructions, including Corrective Measures taken

Time

Actual / Potential Deficiency - Risk Rating

Quality

Purpose of Site Visit

Audit Inspection Investigation

Neotel

Internet Solution

Non-Conformance Report FormIdentification

Vodacom

ATC Employee Reporting

Location / Site Name

Customers

Date

Non-Conformance Classification

Safety Health Environment

Site Number

Cell C

MTN

iBurst

Basillius

Comsol

Debarko

8ta

Responsible Person Date

Proposed Corrective Action

Responsible Customer Due Date

Action sufficient?
ATC South Africa Approval Date: 2012/03/20

Document number: HSE-FRM-0020Title: Non-Conformance Report Form Rev: 2

Owner: Limpho MatoloPage 1 of 1

Investigation Findings (attach photos to substantiate the findings ) / Select INSERT and then select PICTURE

Non-Conformance Report Form

Non-Conformance Report FormPhotos

Detail on what happened during the site visit: undefined_28: undefined_29: undefined_30: undefined_31: undefined_36: Investigation Findings: Employee Reporting: Site Name: Site Number: 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 11: 13: 12: 14: 15: 24: 25: 26: 27: 28: 29: 30: 31: 32: 16: 17: 18: 19: 20: 21: 22: 23: y1: y2: y3: y4: m1: m2: d1: d2: c1: c2: c3: c4: c6: c7: c8: c9: c10: c11: c12: c13: c15: c17: c19: c14: c16: c18: c23: c24: c25: c26: c27: c28: Issued by: c20: c21: c22: c29: c30: a: c31: b: