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					                                                                      SUPPLIER SELF SURVEY


Supplier Name                                           Address:                                      City/ town                                      ZIP
Supplier Phone #                      Fax Number                                Web Page Address:

SUPPLIER REPRESENTATIVES
A.   Name                                               Position                           Phone                           e-mail address
B.   Name                                               Position                           Phone                           e-mail address
C.   Name                                               Position                           Phone                           e-mail address
D.   Name                                               Position                           Phone                           e-mail address
E.   Name                                               Position                           Phone                           e-mail address
F.   Name                                               Position                           Phone                           e-mail address

FACILITIES
Number of Manufacturing Locations               List Different Locations                                            Age of Plant (yrs)
Total facilities area                 square feet   Total manufacturing area                   square feet   Engineering / lab facilities               square feet

PERSONNEL
Total number of employees                Production hourly                 Quality hourly        Quality salaried                  Support areas salaried
Turnover ratio hourly             %    Turnover ratio salaried              % Average experience with company (yrs)

COMPANY PROFILE
Products produced at this facility?                                                                                             Current Customer PPM
Current Assets / Debt Ratio                                Sales Volume at this location                      Union affiliation       yes     No
List of Major Customers                                                      Percent of total sales            % On-time Delivery Performance                         %
List of Major Customers                                                      Percent of total sales            % On-time Delivery Performance                         %
List of Major Customers                                                      Percent of total sales            % On-time Delivery Performance                         %
List of Major Customers                                                      Percent of total sales            % On-time Delivery Performance                         %


COMPANY QUALITY SYSTEM APPROVALS
ISO 3rd Party Certified        YES       NO       9001            9002       QS 9000       TS 16949      ISO/IEC 17025                      CE APPROVAL
ISO Compliant                  YES       NO    Plans for Certification?      YES     NO
Environmental Certified        YES       NO        ISO 14000                 Sony Green (SS-0259) Plans for Certification?              YES      NO
Customer Approvals of Quality System          YES     NO      List Customers?




E571-117 Rev B       Dated: 10/3/03
                                 TAX PAYER IDENTIFICATION NUMBER REQUEST
Please complete the following information. We are required by law to obtain your taxpayer identification number when making a reportable
payment to you. If you do not provide us with this information your payments may be subject to a 31% federal income tax backup
withholding and you may be subject to a $50 penalty imposed by the IRS under section 6723.


INSTRUCTIONS:                    Find your tax status and fill in the information requested. Sign and date the form, then return it to us
                                 in the business reply envelope enclosed.

TAX STATUS:
CORPORATION: EXEMPT, CHARITY OR OTHER EXEMPT ENTITY

Name of Corporation or Charity                                                    TIN / EIN

SOLE PROPRIETOR:
Business Owner’s Name                                                   Social Security Number
Business or Trade Name                                                  TIN / EIN OF BUSINESS

INDIVIDUAL:
Individual’s Name                                                       Social Security Number

PARTENERSHIP:
Name of Partnership                                                     TIN / EIN OF PARTNERSHIP

CHECK QUALIFYING EXEMPTION REASON:
   1. CORPORATION OR INCOPORATED                          5. A DEALER IN SECURITIES
   2.EXPEMPT FROM TAX UNDER 501(a)                        6. A FINANCIAL INSTITUTION
   3.AN INTERNAL ORGANIZATION
   4. THE UNITED STATES OR ANY OF ITS AGENCIES; or A STATE, THE DISTRICT OF COLUMBIA, A POSSESSION OF THE U.S., OR
   ANY OF THEIR POLITICAL SUBDIVISIONS
PERSON COMPLETING THIS FORM
DATE AND PHONE NUMBER:

SIGNATURE: ____________________________________              DATE:____________________________


E571-117 Rev B   Dated: 10/3/03
DIRECTION COMPLETE THE SURVEY:
SELECT THE RATING BY PLACING AN X IN THE APPROPRIATE BOX. THE RATING SCHEME WILL BE AS FOLLOWS:
  5 = Requirement is met, documented evidence is available to support. Record objective evidence, as appropriate.
  4 = Requirement is met, but no documented procedure is available, records must be available.
  3 = Requirement is partially met, documented evidence is available to support. Record objective evidence, as appropriate and list area
      not compliant.
  2 = Requirement is partially met, no documented procedure is available, records must be available when required, Record areas not
      compliant.
  1 = Quality System does not address
N/A = Not applicable to this industry

#  Requirement                                                  Clause    Objective Evidence / Notes                Rating
MANAGEMENT PHILOSOPHY
1.1   Has the supplier’s management with executive              4.1.1                                                 5   4   3   2   1   N/A
      responsibility defined and documented its quality
      policy, objectives for quality, ands its commitment to
      quality?
1.2   Is the quality policy relevant to organizational goals    4.1.1                                                 5   4   3   2   1   N/A
      and expectations and needs of the customer?
1.3   Is the quality policy implemented, understood and         4.1.1                                                 5   4   3   2   1   N/A
      maintained throughout the organization?
1.4   Has the responsibility, authority, interrelationship of   4.1.2.1                                               5   4   3   2   1   N/A
      personnel who manage, perform, and verify work-
      affecting quality been defined and documented?
1.5   Is authority delegated to personnel who have              4.1.2.1                                               5   4   3   2   1   N/A
      organizational freedom to:
          •    Prevent nonconformity occurrence?
          •    Identify & record quality problems?
          •    Initiate, implement & verify corrective
               action?
          •    Control of further processing?
          •    Represent the needs of the customer in
               internal functions?

1.6   Has the supplier identified the resource requirements,    4.1.2.2                                               5   4   3   2   1   N/A
      and provided adequate resources including the
      assignment of trained personnel for management,
      performance of work and verification activities,
      including internal audits?
1,7   Is there a clearly identified management                  4.2.2.3                                               5   4   3   2   1   N/A
      representative with authority and responsibility to
      ensure Quality System compliance, and to report to
E571-117 Rev B      Dated: 10/3/03
       management
1.8    Does the supplier have a system in place to ensure       4.1.2.4    5   4   3   2   1   N/A
       management of appropriate activities during concept
       development, prototype and production?
1.9    Does the supplier use a multi-disciplinary approach      4.1.2.4    5   4   3   2   1   N/A
       for decision making?
1.10   Does the supplier have the ability to communicate        4.1.2.4    5   4   3   2   1   N/A
       necessary information and data in the customer
       prescribed format?
1.11   Is management with responsibility and authority for      4.1.2.5    5   4   3   2   1   N/A
       corrective action promptly informed of products or
       processes that become non-compliant with specified
       requirements?
1.12   Does the supplier’s management with executive            4.1.3,     5   4   3   2   1   N/A
       responsibility review all quality systems elements at    4.1.3.1,
       defined intervals to insure its continuing suitability   4.16
       and effectiveness
1.13   Does the supplier utilize a formal, documented,          4.1.4      5   4   3   2   1   N/A
       comprehensive business plan that includes short-term
       and longer-term goals and plans?
1.14   Is the business under document control?                  4.1.4      5   4   3   2   1   N/A
1.15   Are goals and plans based                                4.1.4      5   4   3   2   1   N/A
1.16   Are there methods in place to determine current and      4.1.4      5   4   3   2   1   N/A
       future customer expectations?
1.17   Does the supplier have an objective process that         4.1.4      5   4   3   2   1   N/A
       defines the scope and collection of information
       (customer expectations and customer satisfaction),
       frequency and methods of collection
1.18   Are there documented methods to track, update,           4.1.4,     5   4   3   2   1   N/A
       revise and review business plan to ensure it is          4.1.6
       communicated and followed throughout the
       organization, as appropriate?
1.19   Does the supplier document trends in the quality,        4.1.5      5   4   3   2   1   N/A
       operational performance, and current quality levels
       for key product and service features?




E571-117 Rev B      Dated: 10/3/03
1.20   Are trends in data and information compared with :         4.1.5   5   4   3   2   1   N/A
           •    competitors
           •    appropriate bench marks
           •    progress toward business objectives, to lead
                the appropriate action to support:
                -    developing priorities for resolving
                     customer problems
                -    determination of key customer related
                     trends
1.21   Is there a documented process to measure customer          4.1.6   5   4   3   2   1   N/A
       satisfaction that includes frequency of determination,
       and how objectively and validity are assured?
1.22   Are trends in customer satisfaction and key indictors      4.1.6   5   4   3   2   1   N/A
       of customer dissatisfaction documented, supported be
       objective information, and reviewed by senior
       management?
1.23   Has a quality manual been prepared? Does the               0.1     5   4   3   2   1   N/A
       quality manual include or make reference to quality
       system procedures and outline the structure of the
       documentation used in the quality system?
QUALITY SYSTEM
2.1    Are there adequate supporting procedures (Level 2)         4.2.2   5   4   3   2   1   N/A
       for each element of the quality manual?
2.2    Is the quality planning process consistent with all        4.2.3   5   4   3   2   1   N/A
       other requirements of the quality system, documented
       in a suitable format, and does it consider as
       appropriate the elements of the quality system that
       address:
                -    Identification and acquisition of all
                     inspection & production/service
                     resources?
                -    Conducting design and process
                     feasibility resources?
                -    Updating and maintenance of all quality
                     control and methodology?
                -    Identification of suitable verification at
                     appropriate stages?
                -    Production, installation and servicing
                     processes which directly affect quality?
                -    Preparation of control plans and
                     FMEAs?
                -    Review of standards and specifications?



E571-117 Rev B       Dated: 10/3/03
2.3    Is there evidence of an implemented advanced              4.2.3.1;    5   4   3   2   1   N/A
       product quality planning process?                         4.2.3.2
2.4    Does the supplier convene multi-disciplinary teams        4.2.3.1     5   4   3   2   1   N/A
       for the production of new or changed products, that
       use appropriate techniques as listed in the Advanced
       Product Quality Planning and Control Plan Reference
       Manual?
2.5    When required by the customer (Littelfuse), are the       4.2.3.2     5   4   3   2   1   N/A
       process steps that affect Special Characteristics in
       process control guidelines and similar documents
       marked with the customer’s special characteristic
       symbol?
2.6    Is the manufacturing feasibility investigated,            4.2.3.3     5   4   3   2   1   N/A
       confirmed, and documented, (Team Feasibility
       Commitment form), prior to contracting proposed
       products?
2.7    Do the supplier’s design control and process control      4.2.3.4     5   4   3   2   1   N/A
       policies and practices consider as appropriate due care
       and product safety?
2.8    Does the supplier promote internal awareness of           4.2.3.4     5   4   3   2   1   N/A
       safety considerations?
2.9    Do process FMEAs consider all special                     4.2.3.5     5   4   3   2   1   N/A
       characteristics?
2.10   Is there evidence of efforts to achieve defect            4.2.3.5     5   4   3   2   1   N/A
       prevention verses detection, using PFMEA
       information?
2.11   Are mistake proofing techniques utilized where            4.2.3.6     5   4   3   2   1   N/A
       appropriate, which include but are not limited to         4.10,3
       planning of process, facilities, equipment and tooling,   4.14.1..2
       and in problem resolution?
2.12   Are control plans developed by multi-disciplinary         4.2.3.7     5   4   3   2   1   N/A
       approach to the system, subsystem, component,
       and/or material level, and list all controls used for
       process control?
2.13   Does the control plan include information required in     4.2.3.7     5   4   3   2   1   N/A
       the Control Plan form in QS-9000 Appendix J?
2.14   Do control plans cover three phases: prototype, pre-      4.2.3.7     5   4   3   2   1   N/A
       launch, and production, as required by the customer?




E571-117 Rev B       Dated: 10/3/03
2.15   Are control plans reviewed and updated as                4.2.3.7    5   4   3   2   1   N/A
       appropriate when any of the following occurs:
          •    product or process changes
          •    processes are found to be unstable or non-
               capable
          •    inspection method, frequency, etc. is revised?
Product Approval Process
2.16   Does the supplier fully comply with all requirements     4.2.4.1    5   4   3   2   1   N/A
       set forth in the PPAP manual?
2.17   Does the supplier utilize a part approval process for    4.2.4.2    5   4   3   2   1   N/A
       subcontractors?
2.18   Is there evidence that product changes are properly      4.2.4.3    5   4   3   2   1   N/A
       validated?
Continuous Improvement
2.19   Is there objective evidence of continuous                4.2.5.1;   5   4   3   2   1   N/A
       improvement in quality (extending to product             4.1.6
       characteristics), service (timing and delivery), and
       price, that benefit all customers.
2.20   Does continuous improvement extend to product            4.2.5.1    5   4   3   2   1   N/A
       characteristics with the highest priority on special
       characteristics?
2.21   Does the supplier have a prioritized action plan for     4.2.5.1    5   4   3   2   1   N/A
       continuous improvement in processes that have
       demonstrated stability, acceptable capability and
       performance?
2.22   Has the supplier identified opportunities and            4.2.5.2    5   4   3   2   1   N/A
       implemented appropriate projects for quality and
       productivity improvement?
2.23   Has the supplier demonstrated knowledge and used         4.2.5.3    5   4   3   2   1   N/A
       appropriate continuous improvement measures and
       methodologies?
Facilities and Tooling Management
2.24   Is a multi-disciplinary approach used for developing     4.2.6.1;   5   4   3   2   1   N/A
       facilities, equipment, and process planning in           4.2.3.7
       conjunction with the advanced quality planning
       process?
2.25   Does the plant lay-out minimize material travel and      4.2.6.1    5   4   3   2   1   N/A
       handling, facilitate synchronous material flow, and
       maximize value-added use of floor space?




E571-117 Rev B       Dated: 10/3/03
2.26   Are methods developed for evaluating the                 4.2.6.1   5   4   3   2   1   N/A
       effectiveness of existing operations and processes
       which consider the overall work plan, appropriate
       automation, ergonomics and human factors, operator
       and line balance, storage and buffer inventory levels,
       and value added labor content?
2.27   Has the supplier established and implemented a           4.2.6.2   5   4   3   2   1   N/A
       system for tool management that includes
       maintenance and repair facilities and personnel,
       storage and recovery, set-up, and tool change
       programs for perishable tools, tools modification
       including tool design modification?
2.28   Are appropriate technical resources available for tool   4.2.6.2   5   4   3   2   1   N/A
       and gage design, fabrication and full dimensional
       inspection?
2.29   If tooling activities are subcontracted, is there a      4.2.6.2   5   4   3   2   1   N/A
       system to track and follow-up these activities?
CONTRACT REVIEW
3.1    Does the supplier review tender, contract or order to    4.3.2     5   4   3   2   1   N/A
       ensure that the requirements are understood and can
       be met, and if any is understanding arises that the
       differences are resolved prior to contract or order
       acceptance?
3.2    Are customer specific contract requirements deployed     4.3.2;    5   4   3   2   1   N/A
       to the functions concerned and fully met?                4.12.1
3.3    Are there provisions to document and deploy contract     4.3.3     5   4   3   2   1   N/A
       amendments to the functions concerned?
3.4    Are records of order acceptance maintained?              4.3.4;    5   4   3   2   1   N/A
                                                                4.16
DESIGN CONTROL
4.1    Is there a process to deploy information gained from     4.4.1.1   5   4   3   2   1   N/A
       previous design projects to current and future ones of
       similar nature?

Design and Development Planning
4.2    Have design plans for each project been established      4.4.2     5   4   3   2   1   N/A
       and responsibility assigned?
4.3    Are design plans updated as the design evolves?          4.4.2     5   4   3   2   1   N/A
4.4    Are responsible personnel qualified in the “Required




E571-117 Rev B       Dated: 10/3/03

				
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