ASQR 09.2 Form 1 by m4N9Vg


									                                                                                                        UPPAP APPROVAL
UTC Division:                                                                               Customer/Division Name:
Part #:                                                                                     Customer Purchasing Representative:
Part Name:                                                                                  Purchase Order #:
SPD/SMD or Rev.#:                                                                           Customer/Division UPPAP Focal Point:
Drawing Revision:                                                                           Supplier Contact Name:
                                                                         SUPPLIER MANUFACTURING INFORMATION
                                                                                                                                                              Purchase Order Type
                                             Supplier Name                                                       Supplier Code                                   1st Tier - UTC
                                                                                                                                                                 Sub-Tier - Indirect

                                   Address (Street, City, State, Code)                                              Country
                                                                             REQUIRED SUBMISSION LEVEL
                                                           All submissions are made to the Customer/Division UPPAP Focal Point
                LEVEL 1 Submit ASQR-09.2 Form 1 only                                  LEVEL 3: Submit ASQR-09.2 Form 1 & complete supporting data

                LEVEL 2: Submit ASQR-09.2 Form 1 & limited supporting data            LEVEL 4: Reviewed at supplier's mfg location - ASQR-09.2 Form 1 & complete supporting data

                                                                         SPECIFIED PLAN ELEMENT REQUIREMENTS
Yes              No    WIP N/A ELEMENT DESCRIPTION                             Yes     No   WIP N/A ELEMENT DESCRIPTION

                                 1. Released Production Drawings                                        10. Measurement System Analysis Studies
                                 2. SPD/SMD and SI sheets (as applicable)                               11. Engineering Frozen Planning/Source Approval            (if applicable)

                                 3. Production Purchase Order                                           12. Dimensional Reports, including Visual Appearance
                                 4. Design FMEA (if applicable)                                         13. Production Verification Testing (PVT)     (if applicable)

                                 5. Process Flow                                                        14. Special Process Approvals including NDT         (if applicable)

                                 6. Process FMEA                                                        15. Material Certification Documentation
                                 7. Process Control Plan                                                16. Raw Material Approval   (if applicable)

                                 8. Process Readiness Study (PRS)                                       17. Parts Marking Approval
                                 9. Initial Process Studies                                         18. Packaging, Preservation & Labeling Approval
                                               Note: Work in Process ("WIP") and "No" selections requires an Action Plan Item be documented below.
                 No.                                                     Action Item                                                            Element #                       Target Date
  Action Plan

I, the supplier, submit this UPPAP Approval form as declaration of having met all applicable requirements of ASQR-09.2, except as noted above, including having implemented the
requirements at the sub-tier level where applicable. I further certify that our production process meets all product delivery, engineering and quality requirements. I understand that the
approval of this form by the customer does not release me from responsibility or liability for any non-conformances.
                                                                             Supplier Management Authorization

Clearly Print Name & Sign                                                     Title                              Email Address                                                       Date
                                                                             Customer Use Only (UTC or 1st Tier)
                Approved         Interim Approval - Class:           Estimated date of full approval:                                                                                  Not approved

                          Customer Authorization: Clearly Print Name and Sign                                         Title                                                          Date

ASQR-09.2 Form 1 (Revision 1, 8/2011)

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