Product Deviation Report

Quality Issue

Entire below section must be completed unless otherwise indicated. Please be as detailed as possible in the description of the product and its deviation.

Date*
Date Format: MM slash DD slash YYYY
Customer Name*
Customer PO #:*
Customer Item #:*
Contact Name*
Contact Email*
Product Description:*
Future PolyTech Job #:*
Defect*
Total Amount of Deviated Product:
Deviated Product Disposition - On Hold
Deviated Product Disposition - Disposed Of*
Deviated Product Disposition - Used
Deviated Product Disposition - Other**
Notes:
*Product can be disposed of only after Future PolyTech managerial approval.
**If amount is entered for “Other” disposition, please describe the product’s status:
Enter a DETAILED Description of Deviation here (provide photos if possible):*
Describe any changes to product usage requirements, specification requirements, etc. that may have occurred:*
Photo Upload (if applicable)
Drop files here or

Accepted file types: jpg, gif, png, pdf.
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Product Deviation Report

Quality Issue

Total Amount of Deviated Product:

Our Company

Capabilities & Services

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