Equipment Failure Non-Conformance Report
Report Details
Date:
Reported By:
Department:
Equipment Name/ID:
Location:
Description of Failure
Failure Date & Time:
Description:
Observed Symptoms:
Impact Assessment
Impact on Operations:
Environmental/Safety Impact:
Initial Actions Taken
Immediate Corrections/Fixes:
Is Equipment Isolated/Tagged Out?
Yes
No
Root Cause Investigation
Preliminary Investigation Details:
Corrective/Preventive Actions
Actions Recommended:
Responsible Person:
Target Date:
Approval
Reviewed By:
Date:
Signature: