**Refer to Light Sources Directorate procedure \"** **[Nonconformance
and Preventive and Corrective
Action](http://www.nsls.bnl.gov/newsroom/publications/manuals/qa/DL-QAP-0801.pdf)\"
on the [NSLS QA website](http://www.nsls.bnl.gov/esh/qa/) for complete
details and requirements for completing design reviews. Contact the
[NSLS or NSLS II QA
Rep.](http://www.nsls.bnl.gov/organization/section.asp?id=CB) or
[QCC](http://www.nsls.bnl.gov/organization/section.asp?id=CB)/DRA for
further guidance.**

  -----------------------------------------------------------------------
  **Light Sources Directorate N****onconformance Report**

  **ESH&Q Risk Level:** **     **
  -----------------------------------------------------------------------

+---------------------------+----------------+------------------------+
| **Originator(s):**        | **Date:**      | **Report Number:**     |
|                           |                |                        |
|                           |                |                        |
|                           |                | (Obtain From QCC/DRA)  |
+---------------------------+----------------+------------------------+

+-----------------------------------------------------------------------+
| **Nonconformance Description:**                                       |
|                                                                       |
|                                                                       |
+-----------------------------------------------------------------------+

+--------------+---------------+---------------------+-----------------+
| **ILR/P.O.   | **Part        | **Part Number:**    | **Qty.**        |
| No.**        | Name:**       |                     |                 |
|              |               |                     |                 |
|              |               |                     |                 |
+--------------+---------------+---------------------+-----------------+

+-----------------------------------------------------------------------+
| **Steps to Prevent Inadvertent Use of the Item or Process:**          |
|                                                                       |
|                                                                       |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Corrective/Preventive Action** **and Disposition**                  |
+-----------------------------------------------------------------------+
| **Apparent Cause:**                                                   |
|                                                                       |
|                                                                       |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Root Cause Analysis Required? Yes** **No**                          |
|                                                                       |
|                                                                       |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Planned Corrective/Preventive Action: Independent verification      |
| required? Yes** **No**                                              |
|                                                                       |
| **Comments:**                                                         |
+-----------------------------------------------------------------------+

  --------- -------------------------------------------------------------------
  **No.**   **Corrective Action**

                 

                 

                 

                 

                 

                 
  --------- -------------------------------------------------------------------

  -----------------------------------------------------------------------
  **Entered into ATS? Yes** **No**     

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------
  **DISPOSITION** (if applicable)**:** Use-as-is Repair Rework Return to
  Vendor Scrap Other      

  -----------------------------------------------------------------------

+---+--------------------------+-------+------------------------------+
| * |                          |       | **Approval of                |
| * |                          |       | Corrective/Preventive        |
| P |                          |       | Action**                     |
| e |                          |       |                              |
| r |                          |       | \_\_\_\_                     |
| s |                          |       | \_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| o |                          |       | \_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| n |                          |       | \_\_\_\_\_\_\_               |
| ( |                          |       |                              |
| s |                          |       | *Cognizant Manager or        |
| ) |                          |       | Designee Date*               |
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| * |                          |       |                              |
| * |                          |       |                              |
+---+--------------------------+-------+------------------------------+
| * | *Name(s)*                | *Due  |                              |
| * |                          | Date* |                              |
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| o |                          |       |                              |
| . |                          |       |                              |
| * |                          |       |                              |
| * |                          |       |                              |
+---+--------------------------+-------+------------------------------+
|   |                          |       |                              |
|   |                          |       |                              |
+---+--------------------------+-------+------------------------------+
|   |                          |       |                              |
|   |                          |       |                              |
+---+--------------------------+-------+------------------------------+
|   |                          |       |                              |
|   |                          |       |                              |
+---+--------------------------+-------+------------------------------+
|   |                          |       |                              |
|   |                          |       |                              |
+---+--------------------------+-------+------------------------------+
|   |                          |       |                              |
|   |                          |       |                              |
+---+--------------------------+-------+------------------------------+
|   |                          |       |                              |
|   |                          |       |                              |
+---+--------------------------+-------+------------------------------+
| * |                          |       |                              |
| * |                          |       |                              |
| C |                          |       |                              |
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| * |                          |       |                              |
+---+--------------------------+-------+------------------------------+
| * |                          |       | **Independent Verification   |
| * |                          |       | Has Been Completed**         |
| P |                          |       |                              |
| l |                          |       | \_\_\_\_\_                   |
| a |                          |       | \_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| n |                          |       | \_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| n |                          |       | \_\_\_\_\_\_                 |
| e |                          |       |                              |
| d |                          |       | *Name Date*                  |
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| * |                          |       |                              |
| * |                          |       |                              |
+---+--------------------------+-------+------------------------------+
| * | *Name(s)*                | *     |                              |
| * |                          | Date* |                              |
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| o |                          |       |                              |
| . |                          |       |                              |
| * |                          |       |                              |
| * |                          |       |                              |
+---+--------------------------+-------+------------------------------+
|   |                          |       |                              |
|   |                          |       |                              |
+---+--------------------------+-------+------------------------------+
|   |                          |       |                              |
|   |                          |       |                              |
+---+--------------------------+-------+------------------------------+
|   |                          |       |                              |
|   |                          |       |                              |
+---+--------------------------+-------+------------------------------+
|   |                          |       |                              |
|   |                          |       |                              |
+---+--------------------------+-------+------------------------------+
|   |                          |       |                              |
|   |                          |       |                              |
+---+--------------------------+-------+------------------------------+
|   |                          |       |                              |
|   |                          |       |                              |
+---+--------------------------+-------+------------------------------+
| * |                          |       |                              |
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|   |                          |       |                              |
|   |                          |       |                              |
|   |                          |       |                              |
+---+--------------------------+-------+------------------------------+

Please forward completed original to the [Quality Control
Coordinator](http://www.nsls.bnl.gov/organization/section.asp?id=CB),
Bldg. 725C or Documents Records Administrator Bldg. 830M