Nonconformance Change Log Form
Log and track changes made to a nonconformance record, including the reason for the change, impact, and review status.
Nonconformance Record Identification
Linked Nonconformance Report Number
*
Date of Original Nonconformance Detection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of Change Log Entry
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Department / Process Area
*
Please Select
Quality Assurance
Production
Maintenance
Warehouse
Engineering
Operations
Other
Location / Site
*
Change Details
Change Type
*
Correction
Status Update
Containment Update
Root Cause Update
Disposition Update
Due Date Change
Assignment Change
Other
Field(s) Changed
*
Record Status
Containment Action
Root Cause
Disposition
Due Date
Assigned To
Corrective Action
Preventive Action
Other
Previous Value
*
New Value
*
Reason for Change
*
Date/Time of Change
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Impact and Disposition
Severity or Priority
*
Low
Medium
High
Critical
Impact on Product, Process, and Customer
Product
Process
Customer
Regulatory
No Known Impact
Other
Current Disposition / Status
*
Please Select
Open
Under Review
Contained
In Rework
Accepted as Is
Scrap
Closed
Other
Containment Action Taken
Corrective/Preventive Action Reference or CAPA Link
Follow-up Due Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Review and Approval
Change Initiated By
*
Reviewed By
*
Approval Decision
*
Approved
Approved with Comments
Rejected
Needs Revision
Approver Comments
Approval Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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