Field Value

Part Name PartName

Part Number 123
Drawing No. 987
Engineering Change Level 0
Revision Code Revision Code 0.0
Product Code/Description ProdDesc
Core Team CoreTeam
Supplier Name Supplier
Supplier/Vendor Code 123
Street Address 123 Street
City City
Region ST
Postal Code 12345
Country USA
Manufacturing Location CitySt
Date Received 14/07/2020

PO Number 456
Customer Part Number 234
Customer Name/Division CustName
Customer Contact ContactName
Buyer/Buyer Code 789
Street Address 123 Street
City City
Region ST
Postal Code 12345
Country USA

Inspection Facility Name InspectionName

Revision Code 0.0

Instructions
1. Enter all customer, supplier and part information in yellow cells.
These will populate to all other sheets
2. Enter characteristics descriptions and specifications
into the next sheet: Characteristics List
These will populate to all other sheets

Sheets
Characteristics List
Part Submission Warrant
Truck Submission Warrant
Appearance Approval
Dimensional Results
Material Test Results
Performance Test Results
Bulk Materials Requirements
Design Matrix
Product-Process Change
Control Plan
PFMEA
Process Flow Diagram
Inspection Report
Appearance Approval Ford-GM
Appearance Approval - Chrysler
Supplier Checklist
Supplier Request
Interim Recover Worksheet
Engineering Source Approval
Bulk Materials Interim Approval
Process Matrix
PQP Summary
Data Points Coordinates
Team Feasibility Commitment
8-D Report

Revision Code 0.0

© 2010 KnowWare International Inc
2253 S Oneida St Ste 3D
Denver, CO 80224

The copyright for this template is owned by KnowWare International Inc.

Licensed users:
May update this file
May copy this file
May share completed files with co-workers, suppliers and customers

Unlicensed users:
May receive and review completed templates created by licensed users
May NOT use this template to perform their own analysis without a license

To purchase a license:
http://www.qimacros.com/products.php
Email orders@qimacros.com
Call 888 468 1537
Fax a PO to 888 468 1536

Revision Code 0.0

 Characteristics List
Revision Code 014/07/2020
Customer Customer Part Number
CustName 234
Supplier Supplier Part Number
Supplier 123
Part Name
PartName
Characteristic Product or
Number Description Specification SC Process Test Type
1 0.603-0.625 inches
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40

Rev Date 07/14/2020 Revision Code 0.0

 41
42
43
44
45
46

Rev Date 07/14/2020 Revision Code 0.0

http://www.aiag.org/ Part Submission Warrant
Part Name PartName Cust Part Number 234

Shown on Drawing No. 987 Org. Part Number

Engineering Change Level 0 Dated

Additional Engineering Changes Dated

Safety and/or Government Regulation __ Yes __ No Purchase Order No. 456 Weight kg

Checking Aid No. Checking and Engineering Change Level 0 Dated

SUPPLIER MANUFACTURING INFORMATION CUSTOMER SUBMITTAL INFORMATION

Supplier 123 ContactName
Supplier Name & Supplier/Vendor Code Customer Name/Division
CustName CustName
Customer Name/Division
123 Street
Street Address Application
City ST 12345 USA
City Region Postal Code Country

MATERIALS REPORTING
Has customer-required Substances of Concern information been reported Yes No n/a

Submitted by IMDS or other customer format:

Are polymeric parts identified with appropriate ISO marking codes Yes No n/a

REASON FOR SUBMISSION (Check if at least one)

__ Initial Submission __ Change to Optional Construction or Material
__ Engineering Change(s) __ Sub-Supplier or Material Source Change
__ Tooling; Transfer, Replacement, Refurbishment, or additional __ Change in Part Processing
__ Correction of Discrepancy __ Parts Produced at Additional Location
__ Tooling Inactive > than 1 year __ Other - please specify

REQUESTED SUBMISSION LEVEL (Check one)

__ Level 1 - Warrant only (and for designated appearance items, an Appearance Approval Report) submitted to customer.
__ Level 2 - Warrant with product samples and \imited supporting data submitted to customer.
__ Level 3 - Warrant with product samples and complete supporting data submitted to customer.
__ LeveI 4 - Warrant and other requirements as defined by customer.
__ Level 5 - Warrantwith product samples and complete supporting data reviewed at supplier's manufacturing location.

SUBMISSION RESULTS
The results for __ dimensional measurements __ material and functional tests __ appearance criteria __ statistical process package
These results meet all drawing and specification requirements; __ Yes __ NO (If "NO" - Explanation Required)
Mold / Cavity / Production Process

DECLARATION
I hereby affirm that the samples represented by this warrant are representative of our parts, which were made by a process that meets all Production Part
Approval Process Manual 4th Edition Requirements. I further affirm that these samples were produced at thed production rate of ____ / ___ hours.
I also certify that documented evidence of such compliance is on file and available for review. I have noted any deviations from this declaration below.

EXPLANATION/COMMENTS:

Is each Customer Tool properly tagged and numbered? __ Yes __ No

Organization Authorized Signature Date

Print Name Phone No. FAX No.

Title Email

FOR CUSTOMER USE ONLY (IF APPLICABLE)

Part Warrant Disposition: __ Approved __ Rejected __ Other

Customer Signature Date

Revision Code 0.0

Print Name Customer tracking Number (optional)

Revision Code 0.0

Truck Industry Part Submission Warrant
Part Name PartName Cust Part Number 234 Rev.

Engineering Drawing
Tool PO Number 456 Change Level 0 Dated

Additional Engineering Changes Dated

Shown on Drawing No. 987 Org. Part Number

Checking Aid No. Checking and Engineering Change Level Dated

ORGANIZATION MANUFACTURING INFORMATION SUBMISSION INFORMATION

Supplier CustName
Organization Name and Code Customer Name/Division
123 Street ContactName
Street Address Customer Contact
City ST 12345
City Region Postal Code Country Application

Note: Does this part contain any restricted or reportable substances? Yes No

Are plastic parts indentified with appropriate ISO marking codes? Yes No

REASON FOR SUBMISSION (Check if at least one)

__ Initial Submission __ Change to Optional Construction or Material
__ Engineering Change(s) __ Sub-Supplier or Material Source Change
__ Tooling; Transfer, Replacement, Refurbishment, or additional __ Change in Part Processing
__ Correction of Discrepancy __ Parts Produced at Additional Location
__ Tooling Inactive > than 1 year __ Other - please specify

REQUESTED SUBMISSION LEVEL (Check one)

__ Level 1 - Warrant only (and for designated appearance items, an Appearance Approval Report) submitted to customer.
__ Level 2 - Warrant with product samples and \imited supporting data submitted to customer.
__ Level 3 - Warrant with product samples and complete supporting data submitted to customer.
__ LeveI 4 - Warrant and other requirements as defined by customer.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
(Check)
__ Level 5 - Warrant with product samples and complete supporting data reviewed at supplier's manufacturing location.

DECLARATION
I affirm that the samples represented by this warrant are representative of our parts, and have been made to the applicable customer
drawings and specifications and are made from specified materials on regular production tooling with no operations other than the regular
production process. I also certify that documented evidence of such compliance is on file and available for review.

EXPLANATION/COMMENTS:

List Molds / Cavities / Production Processes

Organization Authorized Signature Date

Print Name Phone No. FAX No.

Title Email

FOR CUSTOMER USE ONLY

PPAP Warrant Disposition: __ Approved __ Rejected Comment:
__ Interim Approval
Customer Signature Date
__/__/__
Print Name

Revision Code 0.0

http://www.aiag.org/ APPEARANCE APPROVAL REPORT http://www.qimacros.com/ppap-form.html
Part Drawing Application
Number 123 Number 987 Vehicles
Part Buyer E/C Level Date
Name PartName Code
Organization Manufacturing Supplier/Vendor
Name Supplier Location CitySt Code 123
Reason for Part Submission Warrant Special Sample Re-Submission Other
Submission Pre Texture First Production Shipment Engineering Change

APPEARANCE EVALUATION
Authorized Customer
Organization Sourcing and Texture Information Pre-texture Representative
Evaluation Signature and Date
Correct and
Proceed
Correct and
Resubmit
Approved to
Etch/Tool/EDM

COLOR EVALUATION
Color
Color Tristimulus Data Master Master Material Material Hue Value Chroma Gloss Metallic Shipping Part
Suffix Number Date Type Source Brilliance Suffix Disposition
DL* Da* Db* DE* CMC Red Yel Grn Blu Light Dark Gray CleanHigh Low High Low

Comments

Organization Phone No. Date Authorized Customer Date

Signature Representative Signature

Revision Code 0.0

Click on
Other
Sheets at
bottom of
the page

Revision Code 0.0

 Production Part Approval -
Dimensional TestResults Page ___ of ___
Organization Supplier Part Number
Supplier/Vendor Code: 123 Part Name
Name of Inspection Facility InspectionName Design Record Change Level:
Engineering Change Documents

Test Qty. Organization Measurement

Item Dimension/Specification Specification / Limits Date Tested Results (Data)

1 0.603-0.625 inches

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

Blanket statements of conformance are unacceptable for any test results.

Signature Title

Page 11 of 59 Revision Code 0.0

Page 12 of 59 Revision Code 0.0
 Page ___ of ___
123
PartName
hange Level: 0
ge Documents

Not
OK OK

Date

Page 13 of 59 Revision Code 0.0

Page 14 of 59 Revision Code 0.0
 Production Part Approval -
Material Test Results Page ___ of ___
Organization Supplier Part Number 123
Supplier/Vendor Cod 123 Part Name PartName
Material Supplier: Design Record Change Level: 0
*Customer Specified Supplier/Vendor Code: 123 Engineering Change Documents
*If source approval is req'd, include the Supplier (Source) & Customer assigned code. Name of Laboratory
Material Spec. Test Qty. Not
No. /Rev / Date Specification / Limits Date Tested Supplier Test Results (Data) OK OK

0.603-0.625 inches

Blanket statements of conformance are unacceptable for any test results.

Signature Title Date

Page 15 of 59 Revision Code 0.0

Page 16 of 59 Revision Code 0.0
 Production Part Approval -
Performance Test Results Page ___ of ___
Organization Supplier Part Number
Supplier/Vendor Code: 123 Part Name PartName
Name of Laboratory Design Record Change Level:
*Customer Specified Supplier/Vendor Code: Engineering Change Documents
*If source approval is req'd, include the Supplier (Source) & Customer assigned code.
Test Specification Test Qty. Supplier Test Results (Data) /
/Rev / Date Specification / Limits Date Tested Test Conditions OK

0.603-0.625 inches

Blanket statements of conformance are unacceptable for any test results.

Signature Title Date

Page 17 of 59 Revision Code 0.0

Page 18 of 59 Revision Code 0.0
 123
PartName
0

Not
OK

Page 19 of 59 Revision Code 0.0

Page 20 of 59 Revision Code 0.0
Bulk Materials Requirements Checklist Project:
Required/ Primary Responsibility Comments/ Approved
Target Date Customer Organization Conditions by / date

Product Design and Development Verification

Design Matrix
Design FMEA
Special Product Characteristics
Design Records
Prototype Control Plan
Appearance Approval Report
Master Sample
Test Results
Dimensional Results
Checking Aids
Engineering Approval

Process Design and Development Verification

Process Flow Diagrams
Process FMEA
Special Process Characteristics
Pre-launch Control Plan
Production Control Plan
Measurement Systems Analysis
Interim Approval

Product and Process Validation

Initial Process Studies
Part Submission Warrant

Elements to be completed as needed

Customer Plant Connection
Customer-Specific Requirements
Change Documentation
Supplier Considerations

Plan Agreed to by: Name / Function Company / Title / Date

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Product Code/Description xxR-yyyyy Basecoat Paint Project # 00001
POTENTIAL CAUSES FUNCTION - DESIRED ATTRIBUTES (POTENTIAL FAILURE MODES)

Good FMVSS (Windshield Adh)

Good Delamination Resistance
Prelim. Special Characteristics

Good Overspray CompatibIlity

Good Accelerated Durabi!ity

Good Repair Processabillty

Workable Visc/Atomlzation
Good Gloss / Image / Peel

Good Circulation StabilIty

Robust Threshold Range

Good Crack Resistance

Good Florida Durability

Good Repair Adhesion

Good Chip Resistance

Good Sag Resistance

Low/Acceptable Odor
Low/Acceptable VOC
Good Hiding Latitude
Good Shelf StabilIty
PROCESSABlLITY

ENVIRONMENTAL
CATEGORY/ CHARACTERISTICS

Good Color Match

PERFORMANCE

HAPS Compliant
No Telegraphing

Stable Rheology
No Mudcracklng
Dirt / Seed Free
APPEARANCE

No Edge Pull
No Pinholing

Crater Free
Failure

Units
Formula Ingredients
ResinA under 40 UNITS
over 50 "
ResinB under 50 Binder Solids
over 35 "
Crossllnker under 20 Binder Solids
over 30 "
SP Rheology Control Additive under 0.5 Total Solids
over 2.5 "
Color Dispersion - B under 1 Total Solids
over 2 "
Solvent D under 5 Formula Wgt
over 15 "
Alcohol Solvent under 2 Formula Wgt
under 4 "
Ingredient Characteristics
Resin A Viscosity under 30 Poise (#1 @ 50)
over 40 "
SP Chrosslinker Imino under 1 %Molar Comp
over 10 "
Product Characteristics
SP Viscosity under 30 sec #4 Ford Cup
over 40 sec "
SP % NV Solids under 57 % N.V. @ 110 C
over 61 "
Resistivity under 0.01 megaohms
over 0.15 "
Process Constraints
Batch Mixing Temp over 70 F
under 110 "
Conditions for Use
Flash Time before clear under 1 Minutes
over 3 "
SP Final Bake Temp over 250  F
under 275 "

Negative Impact On Customer Expectations: High=3; Med=2, Low=1;None=0; Unknown=?

Revision Code 0.0

 Product / Process Change Notification

Complete this form and email to your customer organization whenever customer notification is required by the PPAP
Manual in Table 3.1. Your customer will respond back with an acknowledgement and may request additional change
clarification or PPAP submission requirements.

To: Customer:

Organization Part Number: 123 Engineering Revision Level Revision Cod Dated:

Customer Part Number: 234 Engineering Revision Level Revision Cod Dated:

Purchase Order Number: 456 Safety and/or government regulation:

Application:

ORGANIZATION MANUFACTURING INFORMATION

Name: Supplier
Street Address 123 Street
City, State & Zip: City ST 12345

Customer Plants Affected: Change Type (check all that apply)

__ Engineering Change(s) __ Dimensional
__ Tooling; Transfer, Replacement, Refurbishment, or additional __ Materials
__ Correction of Discrepancy __ Functional
Design Responsibility: Customer Organization __ Appearance

Organization Change That May Affect End Item:

Product Change Engineering Drawing Change New or Revised Subcomponent

Expected PPAP Completion/Submission Date:

DETAILED DESCRIPTION OF PRODUCT/PROCESS CHANGE:

Planned Date of Implementation

DECLARATION
I hereby certify that representative samples will be manufactured using the revised product and/or process and verified,
where appropriate, for dimensional change, appearance change, physical property change, functionally for
performance and durability. I also certify that documented evidence of such compliance is on file and available for customer review
EXPLANATION/COMMENTS:

Name: Title:
Business Phone No: Fax No:
E-Mail: Date:
Note: Please submit this notification at least 6 weeks prior to the planned change implementation !

Contact your customer to determine if this form is available in an electronic format or if this form should be faxed.

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Revision Code 0.0
http://www.aiag.org/ CONTROL PLAN Page 25 of 59
Prototype Prelaunch Production Key Contact/Phone Date(Orig) Date (Rev.)
Control Plan Number 1
Part Number/Latest Change Level 123 Core Team CoreTeam Customer Eng. Approval/Date

Part Name/Description PartName Supplier/Plant Approval/Date Customer Quality Approval/Date

Supplier/Plant CitySt Supplier Code 123 Other Approval/Date (If Req'd) Other Approval/Date

Characteristics Methods
Part/ Process Name/ Machine, Device, Jig, No. Product Process Special Product/Process Evaluation/ Size Freq. Control Reaction Plan
Process Operation Description Tools, for Mfg. Char Specification/ Measurement Method
Number Class Tolerance Technique
1 1 0.603-0.625 inches
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 23
24 24
25 25
26 26
27 27
28 28
29 29
30 30
31 31
32 32
33 33
34 34
35 35
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36 36 Page 26 of 59
37 37
38 38
39 39
40 40
41 41
42 42
43 43
44 44
45 45
46 46

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 Page 27 of 59

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 Failure Mode and Effects Analysis Page 28 of 59
http://www.qimacros.com/free-lean-six-sigma-tips/fmea.html (Process FMEA) AIAG Fourth Edition http://www.aiag.org/ SAE J1739
FMEA Number Insert FMEA#
Process Page 1 of 1
Item Name/number of item Responsibility: Name Prepared by: who
Model Years: model years/programs Key Date: 15/07/2008 FMEA Date: 15/07/2008
Core Team: Team members
Process Step Action Results

Occurrence

Occurrence
Detection

Detection
Potential Cause(s) / Current Process Current Process Responsibility &

Severity

Severity
Potential Effect(s) R. Recommended Actions Taken & R.

Class
Potential Failure Mode Mechanism(s) of Controls Controls P. Target Completion P.
of Failure N. Action(s) Completion Date N.
Failure Prevention Detection Date
Requirements
Name, Part Manner in which part could Consequences on List every potential List prevention List detection Design actions to Name of Actions and actual
Number, or fail: cracked, loosened, other systems, parts, cause and/or failure activities to activities to reduce severity, organization or completion date
Class deformed, leaking, oxidized, or people: noise, mechanism: assure process assure process occurrence and individual and
etc. unstable, incorrect material, adequacy and adequacy and detection ratings. target completion
Function inoperative, improper prevent or reduce prevent or reduce Severity of 9 or 10 date
impaired, etc. maintenance, occurrence. occurrence. requires special
fatigue, wear, etc. attention.

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
Severity of Effect: Occurrence Rating Detection: Stakeholder Effects of Failure Severity
No Effect 1. None 1. Very low <.01/1000 1. Almost Certain Consumer Owner Safety Problem 10
2. Very Minor 2. Low - 1/1000000 2. Very High (e.g., buyer) Major Owner Dissatisfaction 8
Annoyance 3. Minor 3. Low - 1/100000 3. High Moderate Owner Dissatisfaction 6
4. Very Low 4. Moderate - 1/10000 4. Moderate High Minor Owner Dissatisfaction 4
Loss or degradation 5. Low 5. Moderate - 1/2000 5. Moderate Customer Plant Safety Problem 10
of secondary function 6. Moderate 6. Moderate - 1/500 6. Low (Manufacturer) Possible Recall 9
Loss or degradation 7. High 7. High - 1/100 7. Very Low Line Stoppage 8
of primary function 8. Very High 8. High - 1/50 8. Remote Warranty Costs 7
Failure to meet 9. Hazardous with warning 9. Very High 1/20 9. Very Remote AIAG PPAP 4th Scrap 7
safety/regulations 10. Hazardous w/o warning 10. Very High >1/10 10. Almost Impossible Regulatory Penalty 7
Moderate Rework (<25%) 5
Plant Dissatisfaction 4
Minor Rework (<10%) 3

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Revision Co 14/07/2020 Process Flow Diagram
Page
Customer Customer Part Number 1 of 1
CustName 234
Supplier Supplier Part Number
Supplier 123
Part Name Dwg. Number Dwg. Rev Dwg. Date
123 123 0 14/07/2020
Core Team
CoreTeam
Characteristic
Out-
Op. No. Process Description No. going Control Method Description SC

10 1

10

11

12

13

14

15

16

17

18

19

20
Legend
Operation Inspection Op/Ins Transport Delay Storage Other

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Prepared By Date Approved By
14/07/2020 CoreTeam
Characteristic
Out-
Op. No. Process Description No. going Control Method Description SC

10 21

22

23

24

25

26

27

28

29

30

31

32

33

34
35

36

37

38

39

40
Legend
Operation Inspection Op/Ins Transport Delay Storage Other
Prepared By Date Approved By
14/07/2020 0

REC & INSP 010

Use Drawing
Toolbar to Draw
Connectors
TRANSPORT 010

STORAGE 010

Revision Code 0.0

 STORAGE 010

OTHER 010

OPERATION 010

INSPECTION 010

DELAY 010

Legend
Operation Inspection Op/Ins Transport Delay Storage Other
Prepared By Date Approved By
14/07/2020 0

Revision Code 0.0

 Legend
Operation Inspection Op/Ins Transport Delay Storage Other
Prepared By Date Approved By
14/07/2020 0

Revision Code 0.0

 Legend
Operation Inspection Op/Ins Transport Delay Storage Other
Prepared By Date Approved By
14/07/2020 0

Revision Code 0.0

 FIRST ARTICLE INSPECTION REPORT - ISIR

Part Number 123 Date: 14/07/2020 Page 1 of 1

Line # Specification Requirement Measurement Results
Characteristic
Number RANGE OF TOLERANCE Sample 1 Sample 2 Sample 3 Comment
1 0.603-0.625 inches
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44

Rev Date 07/14/2020 Revision Code 0.0

 45
46

Rev Date 07/14/2020 Revision Code 0.0

http://www.aiag.org/ APPEARANCE APPROVAL REPORT http://www.qimacros.com/ppap-form.html
Part Drawing Application
Number 123 Number ### Vehicles
Part Buyer E/C Level Date
Name PartName Code ###
Supplier Manufacturing Supplier
Name Supplier Location CitySt Code 123
Reason for Part Submission Warrant Special Sample Re-Submission Other
Submission Pre Texture First Production Shipment Engineering Change

APPEARANCE EVALUATION
Customer
Supplier Sourcing and Texture Information Pre-texture Representative
Evaluation Signature and Date
Correct and
Proceed
Correct and
Resubmit
Approved to
Texture

COLOR EVALUATION
Color
Color Tristimulus Data Master Master Material Material Hue Value Chroma GlossMetallic Shipping Part
Suffix Number Date Type Source Brilliance Suffix Disposition
DL* Da* Db* DE* CMC Red Yel Grn Blu Light Dark Gray CleanHigh Low High Low

Comments

Supplier Phone No. Date Customer Date

Signature Representative Signature

Revision Code 0.0

Click on
Other
Sheets at
bottom of
the page

Revision Code 0.0

 APPEARANCE APPROVAL REPORT Page 38 of 59
End Item E/C Supplier Manufacturing Date
Number Level Name Supplier Location CitySt

Component E/C Supplier Supplier Application

123
Part Number Level Contact Phone (Vehicle)

Component PartName Supplier 123 Buyer 789 Customer

Name Code Code Engineer

SURFACE AND TEXTURE EVALUATION

Texture ID Texture Source Texture Location on Part Approvals Customer Representative Signature and Date
Design Studio Pre-Texture
Surface
Engineering Pre-Texture
Concurrence
Mastering Studio Texture
Orientation
Mastering Studio Post
Texture
Ornamentation and
Graphics Not Req'd Req'd
Base or Raw Material Spec. # and Supplier / Supplier# / Lot#

MATERIAL, COLOR, AND GLOSS EVALUATION

Paint or Colorant Spec. # and Supplier / Supplier# / Lot#
Approval
Master Ref. Master Tristimulus & Gloss Part Data
Customer Comments Status
# Color Type Date DL* Da* Db* DE* CMC GLS A R

Supplier Approval Signature Phone

ORNAMENTATION, GRAPHICS AND SURFACE TACTILITY

Type of Ornamentation Customer Approval
and Graphics required Signature

Comments
Customer Approval
Signature

Bold Boxed Areas for Customer Use Only Customer Approval

Signature
January 1, 1999

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 Page 39 of 59

Customer Representative Signature and Date

Customer
Initials / Date

Date

Date

Date

Date

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 SUPPLIER CHECKLIST/APPROVAL for MANAGING CHANGE

Supplier Name Supplier Part Name PartName

Mfg. Location Code CitySt Vehicle Lines Affected

Change Description
ANY ITEMS NOT REQUIRED, PLEASE EXPLAIN: Reqd. Complete Date

1. Engineering and Manufacturing Disciplines:

Layout/Detaill Assy Drawings
Tolerance Stack-Up
Installation Drawings
Reliability Methods
Process Sheets
Engineering Specification
Material Specification
Supplier Component DFMEA
Supplier System DFMEA
Ford Component DFMEA
Ford System DFMEA
Process Flow Chart
Supplier Component PFMEA
Supplier System PFMEA
Ford Component PFMEA
Ford System PFMEA
Ford SDS Update
DV /PV lIP Test
Vehicle Test
Operator Instruction Sheets
Tool & Gage Revisions
Gage R&R Study
Control Plan
Production Trial Run
Sub-Supplier Affect
Service Parts

2. Ford Feasibility Review

Ford Design Engineer Approval
SREA
CR/CR
Alert
PSW
Ford Plant Functional Approval Use Part Submission Warrant (PSW) under "Customer Use Only"
Purchase Order

3. Approvals
Engineering Manager: Quality Manager:
Production Manager: Plant Manager:

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CHANGE

Part Number 123

Ford Plants Affected

Comments

arrant (PSW) under "Customer Use Only"

Revision Code 0.0

 SUPPLIER REQUEST FOR ENGINEERING APPROVAL Ford Specific Instructions
DATE:
SUPPLIER TO COMPLETE
SUPPLIER NAME AND ADDRESS Supplier
123 Street City ST 12345
FORD AND/OR SUPPLIER PART NAME AND PART NUMBER OF ASSEMBLY AND ITS COMPONENTS
EMISSION CONTROL
CODE NUMBER

(SEE FORM 74-107)

CONTROL ITEM AFFECTED

__ YES __ NO

DESCRIPTION OF CHANGE: __ DESIGN __ COMPOSITION __ WEIGHT __ PROCESSING

EFFECT OF CHANGE

INTERCHANGEABILITY AFFECTED TIME REQ'D TO INCORPORATE TOOLING OR FACILITY CHANGES REQD __ YES __ NO
ASSEMBLY __ YES __ NO CHANGE AFTER APPROVAL IF YES, COST EFFECT $
COMPONENTS __ YES __ NO
WILL INCORPORATION OF CHANGE PIECE COST AFFECTED __ YES __ NO
AFFECT SHIPPING SCHEDULE? SIGNATURE IFYES, COST EFFECT $
__ YES __ NO SUPPLIER REPRESENTATIVE

PRODUCT ENGINEERING TO COMPLETE

__ APPROVED. __ RELEASE ACTION REQ'D, NOTICE # __ REJECTED
BY DATE CONCURRED BY DATE
SIGNATURE SIGNATURE

BLANKET APPROVAL GRANTEO FOR SUBSEQUENT SUPPLIER CHECKLIST ATTACHED? SAMPLE OF CHANGED COMPONENT
CHANGES WHICH ARE SAME AS DESCRIBED ABOVE REQUIRED
__ YES __ NO __ YES __ NO __ YES __ NO
REASON FOR REJECTION OR QUALlFYING CONDITIONS OF ACCEPTANCE

REVIEWED BY
SQA Date Purchasing Date
This approval is granted upon the understanding that it is advisory in nature and in no manner changes the Sellers original responsibilIty for insuring
that all characteristics, designated in the applIcable engineering specifications and/or inherent in the samples as originally tested and approved, are
maintained. Seller accepts full responsibility for the changes or types of changes lIsted above; and should such changes result in less satisfactory

Revision Code 0.0

performance than experienced with the originally approved item, Seller will fully reimburse the Buyer for all expenses incurred to correct the deficiency.

Revision Code 0.0

__ YES __ NO

__ YES __ NO

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 INTERIM RECOVERY WORKSHEET (GM 1411) Section II - GM Specific Instructions

Supplier Name: Supplier Part Name: PartName

Supplier Code: 123 Part #: 123
Resubmission Date:
Supplier

Interim Expire Date: EWO#:

Application: ECL: Date:
Submission Level: Kg Wt:
Sample #: INSP/SQE: Add.Sample: Pkg: Interim#

18 INTERIM CLASS Type interim class or circle for manual entry): A B C D E

Customer

19 STATUS: Type or fill In appropriate status (A=Approved, I = Interim, N = Not made),

DIM: APP: LAB: PROCESS: ENG:

20 BRIEF REASONS (116 characters max.)

21 ISSUES (List DIM, APP, LAB, Process, tooling, capacity, Or start-up issues) ACTION PLANS (provide with date of completion)
Supplier

22 WHERE APPLICABLE, ARE INTERIM ISSUES ADDRESSED ON THE GP-12 PLAN? (eg rework, temporary operations)

(Please explain below)

23 SUPPLIER (Authorized signature): Phone:

NAME & TITLE: (Print) FAX:

PART SUBMISSION WARRANT MUST BE iNCLUDED WITH CUSTOMER APPROVALS IN ORDER TO PROCESS YOUR REQUEST AND SEND TO THE PROCURiNG DIVISION

24 CUSTOMER APPROVALS: SIGNATURE NAME (Print) PHONE DATE

SUPPLIER QUALITY ENGINEER:
Customer

PRODUCT ENGINEER (DRE):

LAB/MATERIAL ENGINEER:
APPEARANCE/PAINT ENGINEER:
OTHER (Buyer, Assembly Plant, etc,):

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 Engineering Source Approval for Functional Performance

I. Part Number (s): 123 Supplier: Supplier

Part Name: PartName Duns Code:

Application: ECL: EWO:

Drawing Number: 987 Revision Date: ###

II. The Part Meets All Engineering Performance Requirements. (e.g., Sub System

Tech. Spec., Comp. Tech. Spec., Solar, Validation) __ Yes

III. Comments:

IV. Part not meeting all engineering requirements specified above (section III).

Must be submitted on the GM1411 interim worksheet (the GM-E364 form does not apply).

V. GM Product Engineer: Phone Number:

Date:
(Signature)

(Code)

Supplier -> GM Engineer (DRE) -> Supplier -> SQE/Part Approval Activity

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 BULK MATERIAL INTERIM APPROVAL FORM

SUPPLIER NAME: Supplier PRODUCT NAME: PartName

SUPPLIER CODE: 123 ENG. SPEC.: 987
MANUF. SITE: CitySt PART #: 123
ENG. CHANGE #: 0 FORMULA DATE:
RECEIVED DATE: 14/07/2020 RECEIVED BY:
SUBMISSION LEVEL: EXPIRATION DATE:
TRACKING CODE: RESUBMISSION DATE:

STATUS: (NR Not Required, A Approved, I Interim)

Design Matrix: __ DFMEA: __ Special Product Characteristics: __ Engineering Approval: __
Control Plans: __ PFMEA: __ Special Process Characteristics: __ Process Flow Diagram: __
Test Results: __ Process Studles: __ Dimensional Results: __ Master Sample: __
Measurement Systems Studies: __ Appearance Approval Report: __

SPECIFIC QUANTITY OF MATERIAL AUTHORIZED (IF APPLICABLE):

PRODUCTION TRIAL AUTHORIZATION #:
REASON(S) FOR INTERIM APPROVAL:

ISSUES TO BE RESOLVED, EXPECTED COMPLETION DATE

(CLASSIFY AS ENGINEERING, DESIGN, PROCESS, OR OTHER): ~

ACTIONS TO BE ACCOMPLISHED DURING INTERIM PERIOD, EFFECTIVE DATE

PROGRESS REVIEW DATE: DATE MATERIAL DUE TO PLANT:

WHAT ACTIONS ARE TAKING PLACE TO ENSURE THAT FUTURE SUBMISSIONS WILL CONFORM
TO BULK MATERIAL PPAP REQUIREMENTS BY THE SAMPLE PROMISE DATE?

SUPPLIER (AUTHORIZED SIGNATURE) PHONE

(PRINT NAME) DATE:
CUSTOMER APPROVALS (as needed): PHONE DATE:
PRODUCT ENG. (SIGNATURE)
(PRINT NAME)

MATERIALS ENG.(SIGNATURE)
(PRINT NAME)
QUALITY ENG. (SIGNATURE)

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 (PRINT NAME)
INTERIM APPROVAL NUMBER:

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 Customer Handling, Application Steps and Process Parameters
Special Char & Paint % Paint Gun Gun Gun Cap Gun Gun Booth Booth Bake
Attributes Reduction fluid Atomair Fan distance wash box Temp Humidity temp
flow Air
Dirt Check 1
Film Build 3
Sags 2
Popping 2
Peel 3
Hiding 1
Adhesion 1
Impact Ratings: 3=High, 2=Medium, 1=Low

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 PRODUCT QUALITY PLANNING SUMMARY AND SIGN-OFF
Date: ###

Product name: PartName Part Number: 123

Customer: CustName Manufacturing Plant CitySt

1. PRELIMINARY PROCESS CAPABILITY STUDY QUANTITY

REQUIRED ACCEPTABLE PENDING*

Ppk-SPECIAL CHARACTERISTICS

2. CONTROL PLAN APPROVAL (If req'd) Approved YES/NO* Date Approved

3. INITIAL PRODUCTION SAMPLES

CHARACTERISTIC CATEGORY QUANTITY
SAMPLES CHARACTERISTICS
PER SAMPLE ACCEPTABLE PENDING

DIMENSIONAL
VISUAL
LABORATORY
PERFORMANCE

4. GAGE AND TEST EQUIPMENT QUANTITY

MEASUREMENT SYSTEM ANALYSIS
REQUIRED ACCEPTABLE PENDING*
SPECIAL CHARACTERISTICS

5. PROCESS MONITORING QUANTITY

REQUIRED ACCEPTABLE PENDING*

PROCESS MONITORING INSTRUCTIONS
PROCESS SHEETS
VISUAL AIDS

6. PACKAGING/SHIPPING QUANTITY

REQUIRED ACCEPTABLE PENDING*

PACKAGING APPROVAL
SHIPPING TRIALS

7. SIGN-OFF

TEAM MEMBER/TITLE/DATE TEAM MEMBER/TITLE/DATE

TEAM MEMBER/TITLE/DATE TEAM MEMBER/TITLE/DATE

TEAM MEMBER/TITLE/DATE TEAM MEMBER/TITLE/DATE

*REQUIRES PREPARATION OF AN ACTION PLAN TO TRACK PROGRESS

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 DATA POINT COORDINATES(OPTIONAL)

Data Point Coordinates (Optional)

Control Plan No.

Customer: CustName Date(Orig): Date(Rev):

Char. Point Char. Point Char. Point

No Ident. X Y Z No. Ident X Y Z No. Ident X Y

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DATA POINT COORDINATES(OPTIONAL)

Page 53 of 59 Revision Code 0.0

 DATA POINT COORDINATES(OPTIONAL)

Page 54 of 59 Revision Code 0.0

DATA POINT COORDINATES(OPTIONAL)

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 TEAM FEASIBILITY COMMITMENT
Date: ###
Customer: CustName Part Name: PartName

Part Number: 123

Feasibility Considerations

Our product quality planning team has considered the following questions, not intended to be all-inclusive
in performing a feasibility evaluation. The drawings and/or specifications provided have been used as a
basis for analyzing the ability to meet all specified requirements. All "no" answers are supported with
attached comments identifying our concerns and/or proposed changes to enable us to meet the specified
requirements.

YES NO CONSIDERATION
Is product adequately defined (application requirements, etc.) to enable feas-
ibility evaluation?
Can Engineering Performance Specifications be met as written?
Can product be manufactured to tolerances specified on drawing?
Can product be manufactured with Cpk's that meet requirements?
Is there adequate capacity to product product?
Does the design allow the use of efficient material handling techniques?
Can the product be manufactured without incurring any unusual:
● Costs for capital equipment?
● Costs for Tooling?
● Alternative manufacturing methods?
Is statistical process control required on product?
Is statistical process control presently used on similar products?
Where statistical process control is used on similar products:
● Are the process in control and stable?
● Are Cpk's greater than 1.33?

Conclusion

Feasible Product can be produced as specified with no revisions.

Feasible Changes recommended (see attached)
Not Feasible Design revision required to product product within the specified requirements.

Sign-off

Team Member/Title/Date Team Member/Title/Date

Team Member/Title/Date Team Member/Title/Date

Team Member/Title/Date Team Member/Title/Date

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Revision Code 0.0
 8-D Corrective Action Report
Supplier Name: Part Name:
Supplier Code: Part Number:
Date Opened: Supplier Part Number:

1. Team Details (Name, Dept) 2. Problem Definition

3. Containment Action(s): % Effect

4. Root Cause(s) % Contribution

5. Chosen Permanent Corrective Action(s): % Effect

6. Implemented Permanent Corrective Action(s):

7. Action(s) to Prevent Recurrence:

Review/Modify/Create
FMEA Control Plan Work Instructions
Has Process or Procedure been changed? Yes No
If yes, date of audit:
Auditor:
8. Congratulate your team Close Date
Reported by
Name:
Department:

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Report

Implementation Date

Verification

Implementation Date

Implementation Date

01/01/2009

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