SUPPLIER QUALITY EVALUATION

GENERAL Date: ______

Company Name:
Division Of:
Address:
Telephone: / Fax:
DUNS No: / Cage Code:
Principal Product(s) or Business:
Website:
Years in Business: / Years at this Address:
Your Quality Program is: / is not: approved by a Government Agency or Prime Contractor.
List Agency(s) and/or Prime Contractor(s):
Type of Business: OEM Authorized Distributor Independent Distributor (Broker)
Service Provider Contract Manufacturer (CM)
Quality System is registered to:
ISO-9001 / QS-9000 / ISO 10012-1
ISO-9002 / AS-9000 / ANSI/NCSL Z540-1
AS-9120 / AS-9100
ISO/IEC Guide 25 / Other:

If only compliant, date expected to become certified and/or accredited: ______

** Please provide copies of Registrations/Certifications/Accreditations for the above (as applicable)

Does your Company hold any of the following FAA approvals / Certifications:
PMA / TSOA / MMF
TC / STC / ANSI/NCSL Z540-1
Repair Station / Other:
FAA Approved Drug Testing Plan
FAA Approved Alcohol Misuse Prevention Program (AMPP)

*** please provide copies of the above approvals, restrictions, etc... (as applicable) ***

Does your Company have a counterfeit avoidance program in place:

Yes No Not Applicable

AS 5553 IDEA-STD-1010A CCAP-101 other explain ______

Are you member of: ERAI GIDEP Not Applicable

*** please provide copies of the above approvals, restrictions, etc... (as applicable) ***

Is your counterfeit avoidance program in compliance with DFAR Part 252.246-7007 Contractor Counterfeit Electronic Part Detection and Avoidance Systems?

Yes No Not Applicable

Does your Company have an approved written Quality Manual: YesNo

Quality Manual Revision Level:______Date:______

Is your Quality Manual released under controlled availability: YesNo

Is there a documented management / organizational chart: YesNo

Onsite Contractor audit and/or inspection is currently performed by:

Itinerant DCMC QAR / Resident DCMC QAR
FAA FSDO / FAA MIDO
None / Other:
Total Number of Company Employees: / Total Number of Quality Personnel:
Total Number of Production Personnel: / Total Facility Square Footage:

Your Company’s Quality / Product Assurance contact:

Name: / Title:
Email: / Phone:

Business Type (Check all that apply):

Note: ( FAR 52.219-9 ) Penalties and remedies may be applied to subcontractors for misrepresentation of business status as a small business for the purpose of obtaining a subcontract.

Small Business Concern (SBC) / Small Disadvantaged Business Concern (SBD)
Veteran-Owned Small Business
Concern (VOSB) / Women owned Small Business Concern
Service disabled Veteran-owned
Small Business Concern (VOSB) / Large Business Concern
HUB Zone Small Business Concern
(HUBZoneSB)
Other (Please Specify): ______/ Historically Black College & Universities
(HBCU) and Minority Institutions (MI)

Ultra Electronics Flightline Supplier Compliance

We, ______, are aware of the restrictions stated in the Department of State’s International Traffic in Arms Regulation (ITAR), title 22 of the Code of Federal Regulations (CFR), Chapter I, Subcontract M, Sections 120 130 and agree to comply with all U.S. State Department Export Laws and Regulations.

Please have a responsible official of your company with knowledge of the information included in this statement, sign the acknowledgement below and return a copy to Flightline Systems

Fax: 585-924-1599

Email: or

Date Signed: ______

Name (print): ______

Title: ______

Phone: ______

Email: ______

***NOTE***

suppliers who are submitting a copy of their quality manual and applicable quality system certification(s)/accreditation(s) and/or faa approval(s)/certification(s) need only to complete the signature block on page 8 and forward pages 1 through 4 and Page 8 of this survey back to Flightline Systems with the aforementioned documents. all other suppliers must complete the remainder of this survey and forward the “completed” survey to Flightline Systems prior to award of contract.

FOR FLIGHTLINE USE ONLY

SUPPLIER DISPOSITION: TYPE OF SURVEY:

RECOMMENDEDPRE-AWARD (ON SITE)

CERTIFIEDPRE-AWARD (MAIL IN)

NOT RECOMMENDED  RE-SURVEY (ON SITE)

REGISTERED COMPONENT RE-SURVEY (MAIL IN)

= Requires comments or remarks to clarify disposition. Supplier ID#: ______

SUPPLIER QUALITY EVALUATION

Does the Quality Organization: Yes No N/ARemarks:

Maintain a single quality system ______

Use SPC or TQM ______

Track costs related to quality ______

Perform internal quality audits______

Control the use & number of suppliers ______

Perform quality audits at supplier’s facilities ______

Have a supplier quality rating system ______

Perform contract / purchase order review ______

Coordinate new or special processes ______

Control shelf life material ______

Have controlled areas for:

Non-conforming material ______

Scrap ______

Stock Room material ______

Govt. Bailed material ______

Have electrostatic Discharge control measures ______

According to MIL-STD-1686 ______

Who is Directly Responsible for (if applicable)? Quality Other / Who

Supplier approval / performance ratings ______

Disposition of non-conforming material ______

Analysis of customer returned material ______

Corrective action disposition ______

Control and Rework of production material ______

Configuration Management (hardware / software)______

Process records and test data ______

Product shipping release ______

Reliability, maintainability, etc. ______

Technical literature ______

Failure Reporting / analysis generation ______

Personnel qualification / certification ______

Design / Development / Drawing documentation control ______

Process / procedure control & update ______

Software Quality Assurance______

Inspection / Test: Yes No N/ARemarks

Does the organization?

Have inspection / test procedures ______

Use complete process / work instructions ______

Use & control inspection / test stamps ______

Control & maintain inspection tools / test equipment ______

Does the organization?

Have receiving inspection / test:

Sampling per Mil-Std-105E or equivalent ______

100% inspection of attributes / characteristics ______

To specification / drawing ______

Maintain records ______

In-house testing ______

Require detailed inspection of documentation

and packaging? ______

Does the organization’s processes assure the detection

of counterfeit material prior to formal acceptance? ______

Does the organization’s process require visual

inspection to IDEA-STD-1010, Acceptability of

Electronic Components I the Open Market?______

Does the organization’s process require inspection for

evidence of remarking or resurfacing, if applicable? ______

Does the organization’s process require X-ray inspection,

if applicable?______Does the organization’s process require X-ray Florescence

inspection, if applicable?______Does the organization’s process require destructive

physical analysis, if applicable?______Does the organization’s process require other applicable

tests?______

Does the organization’s receiving and inspection

process require training in detecting and avoiding

counterfeit parts? ______

Have in-process inspection / test:

First piece inspection______

100% inspection of attributes / characteristics______

In-Process Testing ______

Have final inspection / test:

100% inspection of attributes / characteristics ______

Complete an “As built” configuration ______

Acceptance testing of final product______

Identify inspection / test status of product ______

Purchase order traceability of raw stock ______

Capable of in-house raw material analysis ______

Have customer / government furnished material ______

Inspection and/or test Control procedures ______

Have packing, shipping, and storage inspection/instruction______

Manufacturing Yes No N/ARemarks

Does the organization?______If No, then disregard this section

Have adequate capability & equipment ______

Have work instructions / process details ______

Have in-process travel cards / work orders ______

Have assembly identity control ______

Have job training ______

Have controlled hold areas ______

Provide all assembly tools ______

Have a safety awareness program ______

Does the Calibration System: / Yes / No / N/A / Remarks:
Identify Advanced Metrology requirements ?
Have an equipment calibration system that provides calibration for all equipment used ?
Have an internal Metrology lab ?
Have an external Metrology lab ?
Maintain a documented system for the calibration of all Measurement & Test Equipment (M & TE) ? /
Utilize measurement standards which have the accuracy, stability, range, resolution for the intended use and are traceable to the National or International Standards ?
Control environmental conditions to the extent necessary to assure continued measurements of the required accuracy ?
Make consideration for temperature, humidity, vibration, cleanliness, and other controllable factors affecting precise measurement ?
Use published standard practices or manufacturers’ instructions ?
Provide notification to the end user of any M & TE that is discovered to be “out-of-tolerance” during the calibration process ?
Maintain records which show established procedures and schedules are applied to maintain the accuracy of M & TE and other measurement standards ?
Control labeling of M & TE to indicate the date of last calibration, by whom, the due date of the next calibration and use of seals to prevent tampering which could affect calibration ?
Provide a Certificate of Calibration to the customer stating: date of cal., cal. interval, calibrated item. info.(s/n, asset #, etc.), status of calibration, N.I.S.T. traceable #, equip. used, cal ratio, and certificate # ?

* List any special processes:

* Use this section for any additional remarks or comments.

Remarks:

______

Completed by (please print)

______

Signature of person completing formTitle Date

F-0011, Rev. P, 02OCT 2014Page 1 of 8