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Supplier Data Base

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Supplier Data Base document sample

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									      SUPPLIER RESTRICTED SUBSTANCE INFORMATION REPORTING FORM FOR                               (ATTACHMENT 1)
      NON-PRODUCTION DIMENSIONAL MATERIALS/PACKAGING MATERIALS/OFFICE MATERIALS, WSS-M99P9999-A1
       Supplier Name______________________________
       Global Supplier Data Base (GSDB) Code: ________________________
       Supplier Contact: _______________________________
       Supplier Phone: ________________ Ext: ___________________                                                                      Supplier FAX Number: ______________________
       Supplier Email: _____________________________
       Supplier Part Number: ___________________________                                                                              Supplier Part Description: ___________________

       Ford Motor Company Engineering Contact: ________________________________                                    Phone Number: ____________________________

       INSTRUCTIONS: The above item (by part number) contains the following substance(s) listed in the current version of the Ford Engineering Material Standard. Ford Motor
       Company WSS-M99P9999-A1 policy requires that suppliers disclose listed substance information related to the product supplied. Products, for which full disclosure of ingredients
       has been supplied to Toxicology according to Section 3.0 of the Standard, do not require additional reporting.
       Suppliers of facility equipment, machinery, and tooling (e g., conveyers, presses etc.), packaging materials, office materials and any sub-components contained therein, must
       utilize this form to submit information listed below including: 1) the name of the Production Line Equipment TOOLING AFFECTED that the sub-component part services, 2) if the
       part comes into direct contact with EMPLOYEE as a matter of routine use, 3) if the part contacts any material/part integral to the vehicle or other equipment that does so (i.e.,
       affects MARKETS) and 4) if the part is a MAINTENANCE part that is periodically replaced and disposed. Suppliers of Facility equipment, or assembly aides whose main
       component contains no "sub-components", also utilize this form. PLEASE COMPLETE AND RETURN THIS FORM VIA FAX OR EMAIL TO NORTH AMERICAN GLOBAL
       MATERIALS & STANDARDS ENGINEERING : FAX 1-313-322-1614 or email RSMSstat@ford.com . The electronic version of this form is accessible at
       https://us.library.covisint.com/PublicDocViewer?nodeID=2179
        REQUEST FOR ACKNOWLEDGEMENT:                 The above item (by part number) contains the following substance(s) listed in WSS-M99P9999-A1.
            Ford Motor Company will acknowledge receipt of this report
      I CERTIFY THAT THE ITEM(S) IDENTIFIED ON THIS FORM COMPLY WITH WSS-M99P9999-A1

       Form completed by: ___________________________                                                              Department: ___________________________
       Date: ____________________

 Equipment /                                                                     Sub-Component Information                                                                            Check all
Tooling Supplier                                                                                                                                                                      affected
                                                                                                                                                                                               M
                                                                                                                                                                                      E        A
                                                                                                                                                                                      M    M   I
Tooling Affected        Detailed        Supplier                                                                                                                                      P    A   N
                                                                        Material                                    Listed substance by CAS              Listed
 Production Line        Supplier         Part/            Part                                          Material                                                   Primary Purpose    L    R   T
                                                                         Name            Material                   No. AND chemical name              Substance
   Equipment           Part/Spec        Product          Weight                                         Weight                                                     or Use of Listed   O    K   E
                                                               2                         Std No.              3          in Material/Part               Weight                        Y    E   N
    Name(s) /          Numbers
                                 1
                                         Name             (kg)                                           (kg)                                                         Substance
                                                                                                                                                          (kg)                        E    T   E
  Model No.(s)
                                                                                                                                                                                      E    S   N
                                                                                                                                                                                      S        C
                                                                                                                                                                                               E




      Ford Motor Company Acknowledgment: ________________________________________                                  Date: ______________________
      (1)      Supplier Part/Specification number used by Ford for procurement.
      (2)      Report the weight (in kilograms) of the part supplied containing the listed substance.
      (3)      Report the weight (in kilograms) of the material containing the listed substance.
                                                Submit additional signed copies of this form as necessary for additional Equipment/Tooling Suppliers

								
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