Tangguh Expansion Project – LNG EPC

Project NCR Procedure

Appendix 1 – NCR FORM

Form No
NONCONFORMITY REPORT McC-TEP-QA-001

Date: 05 September 2018 Activity/Phase: Construction NCR No: 2781-NCR-TEP-JHS-001

Location: Type of NC (Fault-Failure / Product / Service)
JHS Cikarang Plant

Work Operation Supplier/Vendor

Ref.to QC Plan / STD & Procedure/Code: Name: PT Saeti Centricon Wahana (JHS
1. JHS ITP, TEP-1155422-A99-0147 Rev.03 System)
2. Precast Concrete Specification, TEP-1155422-a99-0038 Rev.05 PO : 27818019
Item/Tag: Precast Concrete Fabrication
Description of the Nonconformity
Headstock Tag ID H107 which casting date on 04-Sep-2018 with fc’ 50 MPa, has found concrete defects
(honeycomb and cold joint) when visual inspection after open formwork on 05-Sep-2018. The defects caused by
Vibrator and Concrete Pump were not properly working, see attachment.
Att1. Repair Map; Att2. Defect pictures.

Originator Name : Ang Hendroyono Signature: Date: 05 September 2018

Quality Function Name : Ang Hendroyono Signature: Date: 05 September 2018

Responsible Function Name : Signature: Date:

Immediate Action Taken (if any): Product Segregation

Process / activity suspension

Responsible Function Name : Signature: Date:

Proposed Correction
NC Correction Type: Due Date
Proposed Correction Description:

Responsible Function Name : Signature: Date:

B
Supplier/Vendor
Name : Signature: Date:
(If required)

Quality Function Name : Signature: Date:

Approval Function Name : Signature: Date:

CONTRACTOR:
Name : Signature: Date:
(If required)

Verification of Correction and Nonconformity Close-out

Root cause analysis and corrective action required (Y / N)
Description

C
Quality Function Name : Signature: Date:

Approval Function Name : Signature: Date:

CONTRACTOR:
Name : Signature: Date:
(If required)

TEP-1155422-H99-0011 Page 1 of 1 Rev: 03

870310-S-1155422-MAR-H99-0011 BP Internal