PSM BrownCo
SUPPLIER QUESTIONNAIRE
SUPPLIER NAME: ______
SUPPLIER ADDRESS: ______
CITY, STATE, COUNTRY: ______
TELEPHONE NUMBER: ______
FAX NUMBER: ______
E-MAIL: ______
CONTACT NAME: ______
SECTION 1
1. Number of years in business? ______Number of employees? ______
2. Have you ever done business with PSM BrownCo ? ð Yes ð No
If yes, please give specifics of when and the nature of the business.
______
______
______
3. Do you currently meet any of the following? (check as many as apply):
· ISO 9001 certified? ð Yes ð No (if yes, Cert. no. ______)
· Registered with Competent Authority? ð Yes ð No (if yes, Reg. no. ______)
· Underwriter’s Laboratories (UL) listed? ð Yes ð No (if yes, List no. ______)
· Other 3rd Party Certification of Facility? ð Yes ð No (if yes, explain ______)
4. Has PSM BrownCo conducted a Site Survey of your facility? ð Yes ð No
5. Have you provided at least three (3) consecutive shipments to
PSM BrownCo that met specified requirements? ð Yes ð No
6. Have you previously provided test samples to PSM BrownCo
which met qualification? ð Yes ð No
7. Do you have a quality system in place? ð Yes ð No
IF YOU ANSWER “NO” TO ALL OF THE QUESTIONS IN LINE 3,
PROCEED TO ANSWER QUESTIONS ON PAGE 2 OF THE SUPPLIER QUESTIONNAIRE.
Yes No
Does your Company have an organizational chart?
Does the organizational chart list all personnel, departments and hierarchy?
Is a quality manual established and maintained?
Are contracts or orders reviewed to ensure that requirements are adequately defined and documented, before acceptance?
Are design control procedures established and maintained?
Are procedures established and maintained to control all documents and data?
Are procedures established and maintained to ensure purchased parts, raw materials, and services conform to requirements?
Do written procedures exist for the control of verification, storage and maintenance of customer-supplied product?
Are procedures established and maintained for identifying the product from receipt, to all stages of production, and delivery?
Are procedures established and maintained for planning, production, installation, and servicing processes?
Are procedures established and maintained for inspection and testing activities?
Are procedures established and maintained to control, calibrate, and maintain inspection, measuring, and test equipment?
Are procedures established and maintained to identify the inspection and test status of product?
Are procedures established and maintained to ensure product not conforming to specified requirements is prevented from unintended use?
Are procedures established and maintained for implementing corrective and preventive actions?
Are procedures established and maintained for handling, storing, packaging, preserving, and delivering the product?
Are procedures established and maintained for identifying, collecting, indexing, accessing, filing, storing, maintaining, and disposing of quality records?
Are procedures established and maintained for planning and implementing quality audits?
Are procedures established and maintained for identifying training needs?
Are procedures established and maintained for performing, verifying, and reporting that servicing meets specified requirements?
Are procedures established and maintained for implementing and controlling the application of statistical techniques?
Completed By: ______
Date: ______
PAGE 3 FOR PSM BROWNCO USE ONLY
PAGE 3 FOR PSM BROWNCO USE ONLY
SECTION 2
SUPPLIER NAME: ______
Supplier Assessment:
Based on this evaluation, or other information (explain here), this supplier is recommended for the following status:
o Add to Approved Supplier List
o Add as Grandfathered
o Approved
o Provisional
o Probationary
o Remove from Approved Supplier List
Completed By: ______
Date: ______
Comments:
PSM BrownCo, QF 74-01, Rev 2, 06/13/03 Page 1 of 3