Raw Material Rejection Report Form
Report rejected raw materials, record inspection findings, and track follow-up actions for quality control.
Reporter and Material Identification
Reporter Name
*
First Name
Middle Name
Last Name
Department / Team
*
Contact Email
example@example.com
Contact Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Supplier / Vendor Name
*
Raw Material Name / Part Number
*
Batch / Lot Number
*
Purchase Order / Receiving Reference
Date of Receipt
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Rejection Details and Inspection
Rejection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspected By
*
First Name
Middle Name
Last Name
Rejection Category
*
Damage
Contamination
Incorrect Specification
Labeling Issue
Shortage
Expired/Aged Material
Other
Detailed Rejection Description
Quantity Received
*
Quantity Rejected
*
Unit of Measure
*
Upload Photos or Supporting Documents
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Disposition and Follow-up
Proposed Disposition
*
Please Select
Return to Supplier
Scrap
Rework
Quarantine
Replacement Requested
Pending Review
Immediate Action Taken
Corrective/Preventive Action Requested
Responsible Department or Owner
Target Follow-up Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Notes / Comments
Submit Report
Should be Empty: