KEYSTONE TURBINE SERVICES, LLCKTS-QA-40007 Revised 10/25/2012

Supplier Quality Mail Survey

INSTRUCTIONS:Failure to fully comply with these instructions may prevent or delay your approval process.All “No” responses require an explanation in the field under each section

A)Company Profile
Supplier Name: / Subsidiary/Division of:
Address:
City: / State: / Zip Code
Telephone: / Web Site:
Location of Facility (if different than above):
Major services provided:
Total Quality Assurance Employees: / Total All Employees:
Quality Dept contact name and title: / Phone:
B)National Aviation Authority Certification
 FAA Certificated Repair Station /  Transport Canada Authorized Maintenance Organization /  None
EASA Part 145 Approved?  Yes  No
Attach a copy of your Air Agency Certificate or Authorized Maintanance Organization Certificate of Approval, Operations Specifications or AMO Ratings, and EASA ApprovalCertificate if applicable
C)Registered Quality System/ Other Approvals or Certificates
AS91____ Rev____ / ISO 9001:______/ Other (please list in the space below)
Attach a copy of your certificate(s)
D) Quality System Assessment
Yes / No
1)Is a preliminary inspection done on customer parts that are received for repair?
2)Do you have the required data for all the work you perform?
3)Do you have a procedure to ensure the data being used is current?
4)Are personnel qualified for the tasks they perform?
5)Are records maintained on personnel for training received and prior work experience?
6)Are supervisory and inspection personnel appropriately certified as required?
7)Do you have procedures to ensure that inspections are performed only by authorized personnel?
8)Are procedures in place to ensure the required Return to Service documents are completed and provided with the product?
9)Does your company have (and fully comply with) FAA approved and DOT Anti-Drug and Alcohol Misuse Program requirements (Ref 14 CFR Part 120)? If yes, please provide a copy of either Ops Specs section A449, or the certificate issued by the testing company.
E) Per FAA requirements customers are required to audit their suppliers. Will you permit an audit of your and your sub-tiers’ QC Systems by the customer, FAA, or other government personnel? Yes No
F) Have there been any changes to your quality system since the last time youwere audited by Keystone Turbine Services or completed a Quality Mail Survey for them? Yes No
If yes, describe the changes below

G)Comments- Please use this space to provide an explanation for each “No” answer and for any additional information or comments:

Completed by:
Signature / Print Name / Title / Date

KEYSTONE TURBINE SERVICES QUALITY ASSURANCE USE ONLY

NOTE: Process per the “Instructions for Approval / Conditional Approval of Supplier Quality Mail Survey” located at S:\Quality\Contracted Maintenance

Approved / Conditional Approval (explain below)
Required Actions:
Receipt Date: / Reviewed By: / Date:

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