Michigan Department of Transportation QA NCR#

0560 (10/20) QUALITY ASSURANCE

NONCONFORMANCEREPORT To be completed by a QAI, combined with other supporting

documentation and submitted to the Structural Fabrication Unit. Naming Convention: 0560 MOOT ID-JN Fabricator QA NCR# REV#.pdf

GENERAL INFORMATION

INSPECTION AGENCY INSPECTOR MOOT ID

FABRICATOR LOCATION JOB NUMBER

JOB DESCRIPTION

ELEMENT MARK DATE I

NONCONFORMANCE DESCRIPTION

• Combine this document with all relevant QC reports, photos, repair plans, WPS, etc. into one PDF document prior to

submitting to the Structural Fabrication Unit.

mailto:MDOT-StructuralFabrication@michigan.gov

QANCR NUMBER: QANCR INSPECTION AGENCY: QANCR INSPECTOR: QANCR FABRICATOR: QANCR LOCATION: QANCR JOB DESCRIPTION: QANCR ELEMENT MARK: QANCR JOB NUMBER: QANCR DATE: QANCR DESCRIPTION: Clear Form button: MDOT ID: