Nonconformance Initiation Form

Nonconformance Initiation Form

Please complete this form for each defective item and a Williams Valve Representative will be in contact shortly.

Company Name*

Full Name of Primary Contact*

Contact Information (email/phone)*

Entered By WEW Employee?

Select check box if you work for Williams E William Valve Corporation

Employee Name/Account Owner

The name you enter here will be the individual visible on their log based on the email, and will indicate who is assigned responsibility for this task.

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Purchased From:

Order Number

End User or Site:

Valve Type*

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Size*

Pressure Class*

Figure Number

Serial Number or Code

Description of Nonconformance or Defect*

Date of Discovery?*

Any repairs attempted? If yes, please explain.*

Desired Action?*

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Any 3rd party modification or actuation?*

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Modified By?*

Details of modification?*

Return for Root Cause Evaluation?*

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Was the valve installed? *

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Did the valve ever work properly? If so, how long?*

If not known, type unknown. However, this information will be needed for an effective root cause.

Media?*

If not known, type unknown. However, this information will be needed for an effective root cause.

Function?*

If not known, type unknown. However, this information will be needed for an effective root cause.

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Pipe Orientation?*

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Valve Stem Orientation?*

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Operating Temperature?*

If not known, type unknown. However, this information will be needed for an effective root cause.

Operating Pressure?*

If not known, type unknown. However, this information will be needed for an effective root cause.

Proximity to closet component: Pump,Elbow,Tee,Etc.*

If not known, type unknown. However, this information will be needed for an effective root cause.

Certificate of Decontamination*

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Please upload any relevant documentation or photos

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