Supplier Self Survey

Filled Out By: / Date:
Signature: /

Signature not required for electronic submissions

On-Site Limited (ISR Use Only)

Performed By: / Date:
Company Name:
Street: / PO Box:
City: / State/Province:
ZIP/Postal Code: / Country:
Main Telephone No.:
Top Facility Manager:
Title: / Phone:
Head of Quality Assurance:
Title: / Phone:
E-mail: / Fax:

Please provide e-mail address for communication with Head of Quality Assurance.

Commodity of Supplier

Commodity / Select From DropdownMachiningNadcap Special ProcessNDTCastingOptics FabricationOptics CoatingCircuit Card AssemblerRigid PCB FabricatorFlex PCB FabricatorOptical AssyMech AssyCables and HarnessesElectrical AssyCalibration ServicePart/Hardware DistEEE Parts Authorized DistributorEEE Parts Non Authorized DistEEE Parts BrokerDetector FabricationTesting - EEETesting - EnvironmentalIC FabricationCustom EEE ManufacturerOther
Other
CAGE CODE

ITAR Registered with Directorate of Defense Trade Controls Yes No

Scope of Survey

The survey will be used to gauge how compliant to AS9100 a supplier is. This survey does not cover all requirements of AS9100. It is focused on those elements considered essential for Product Realization when the supplier is not the designer. The responses are subject to on-site verification by UTAS ISR Supplier Quality Engineering.

Facility Information

Business Structure:

Corporation Individual Partnership

Division of:
Total Number of Employees at this Location:
Number of Quality Control Inspectors
Number of Quality Assurance Engineers
Number of Manufacturing Personnel
Square Footage: / Building Age:

Owned Rented/Leased

Environmental Controls in Work Areas: Temperature - Heat and Cool

Temperature - Heat Only Humidity

Are there Clean Rooms? YES NO

If YES, What Classes?

Unionized Workforce- YES NO

If Unionized – Earliest Contract Expiration Date:

*Certified Quality Management System:

AS9100/9120 ISO 9001 TS16949 Nadcap

Nadcap Processes:

ISO/IEC 17025ANSI/NCSL Z540ISO 14001 ISO 10012

Attach a copy of currentRegistrar issued certificate

Other Certifications:

If none of the above are applicable, describe Quality Management System:

Worker Soldering/Conformal Coat/InspectorCertifications:

Not Applicable

J-STD-001 IPC-A-610 Class1 Class 2 Class 3

J-STD-001 Space Addendum J-STD-001 Nadcap certified

Is an IPC registered instructor on site? Yes No N/A

NASA-STD-8739.3 (Hand Soldering) NASA-STD-8739.4 (cables)

NASA-STD-8739.2 (SMT) NASA-STD-8739.1 (CC and Staking)

Is there a NASA certified Level B Instructor on site Yes No N/A

OthersList:

*Contract Review

Responsible Person: / Title:
Procedure: / Revision:

When reviewing a RFQ, Contract, SOW or Purchase Order, do you assure you have all pertinent documentation including the current drawing revision cited on quote or PO, drawing cited documents (including ISR customer specs cited on drawing or PO) and Quality Requirements related documentation?

YES NO

Review Authorities:

Engineering QA Manufacturing/Operations

Others:
Process Development
Responsible Person: / Title:
Procedure: / Revision:

Are Procedure and Process documents under Configuration Control?

YES NO

Is Process Software (including Numerical Control) under Configurationor Engineering Control?

YES NO N/A Process Software not used

Note: Any manufacturing or test equipment run by software is applicable.

Do all Manufacturing/Operation Procedures, Processes, Travelers/Routers and Software require Approval prior to release? YES NO

Does the Controlling Procedure designate who has Approval authority for each type of document? YES NO

Are Procedures/Processes and Process Software (including Numerical Control) protected against unauthorized change? YES NO

Are Control Plans developed for Key/Critical Characteristics?

YES NO N/A

Are 100% of drawing characteristics accounted for in production/inspection planning? YES NO N/A

Do you have a traceability system to track and permanently record material and/or parts used in manufactured or supplied product?

YES NOIf yes, to what constituent part levels? Lot # Serial #

If yes, to what manufactured product levels? Mfg. Lot # Discrete Serial #

Is there a FOD (Foreign Object Damage/Foreign Object Debris) program in place and functioning? YES NO N/A

*Purchasing

Responsible Person: / Title:
Procedure: / Revision:

Are Customer Requirements flowed down to sub-tier suppliers? YES NO

Are sub-tier suppliers evaluated initially? YES NO

How:

Are sub-tier suppliers re-evaluated periodically? YES NO

How:

Is there an approved supplier list? YES NO

Is there established criteria documented for evaluation and re-evaluation of suppliers? YES NO

Are records of supplier evaluations maintained? YES NO

Are production materials procured only from approved suppliers? YES NO

Are there provisions to disapprove suppliers for cause? YES NO

Are EEE Parts Brokers or Independent Distributors (non-manufacturer authorized) used to procure electronic parts? YES NO N/A

Is there a documented program/process to prevent procuring counterfeitor substandard parts and materials? YES NO

*Distributors Only – Are you an OEM Authorized Distributor for the items procured by ISR?

YES NO

*Receiving Inspection

Responsible Person: / Title:
Procedure: / Revision:

Is all production material inspected upon receipt (except dock to stock items)?

YES NO

Are sampling plans used? YES NO

If used, are the sampling plans C = 0 based (accept on 0, reject on 1)?

YES NO N/A

Are certificates of compliance/conformance reviewed for accuracy to specification, drawing and/or purchase order requirements? YES NO

Are received raw materials tested periodically to verify certification?

YES NO

Is there a counterfeit parts detection program in place and functioning?

YES NO N/A

Are suppliers issued corrective action requests for detected non-conformances?

YES NO

Is there a dock to stock program? YES NO

If yes, are dock to stock items audited periodically? YES NO

Production

Responsible Person: / Title:
Procedure: / Revision:

Are Travelers or Routers (Including electronic routing) used? YES NO

Do the Travelers or Routers have release approval and revision identification?

YES NO

Does the procedure indicate who has authority to change (Including WIP change) and red-line Travelers or Routers? YES NO

Is the status of production items readily identified? YES NO

Are split lots adequately documented? YES NO Not Used

Is there a Preventative Maintenance program in use and up to date for production equipment? YES NO

Is there a shelf life control system for time sensitive materials? YES NO

Do not use time sensitive materials

If yes, is the shelf life control system recall based? YES NO

How are operation completion/acceptance sign-offs recorded?

Stamps Signatures/Initials Electronically

If stamps are used, is there an up to date master stamp list? YES NO

Do personnel receive training commensurate with the tasks they perform and is the training documented?

YES NO

*In-process/Final Inspection

Responsible Person: / Title:
Procedure: / Revision:

Are all production lots/items inspected? YES NO

Are sampling plans used? YES NO

If used, are the sampling plans C = 0 based (accept on 0, reject on 1)?

YES NO

Are First Article Inspection Reports generated for items produced when required? YES per AS9102 YES not per AS9102 NO

Do you have the ability to safely store and retrieve product related quality records for 5-7 years? (May be accomplished electronically) YES NO

Special Process Control

Responsible Person: / Title:
Procedure: / Revision:

Are any Nadcap defined Special processes performed in house? YES NO

If YES what are they?

If YES, are they submitted to customer for approval if required? YES NO

Are you Nadcap certified for the process? YES NO N/A

Does a sub-tier supplier perform any Special Processes? YES NO

If YES, are the Special Processes submitted for customer approval if required?

YES NO

Do you periodically audit them? YES NO N/A

Are they Nadcap certified to perform the Special Process?

YES NO N/A

*Calibration

Responsible Person: / Title:
Procedure: / Revision:

Are all instruments, test equipment and gages used to accept product under Calibration Control?

YES NO

Is the status of calibration of the instruments and gages readily apparent (preferably by sticker affixed to item)?

YES NO

Does the status indicate calibration due date? YES NO

Is there a calibration recall system? YES No

Are calibrations performed by supplier personnel or outside parties?

In Out Both

If calibrated by an outside party, is a Certificate of Calibration provided for each item calibrated? YES NO N/A

If yes, is the Certificate of Calibration compliant to national or international standards (e.g. ANSI-Z540 or ISO/IEC 17025)? YES NO

Are the Certificates of Calibration reviewed by internal personnel for accuracy and completeness? YES NO

Is this review documented? YES NO

The following five questions pertain to both internally and externally performed calibrations:

1. Are calibration standards traceable to recognized master standards such as NIST?

YES No

2. Do calibration records include pre and post adjustment data? YES NO

3. Do calibration records include a listing of calibration equipment used and its calibration status? YES NO

4. Do calibration records include a listing of the specific calibration procedures used for each item?

YES NO

5. Are the individual calibration procedures approved for use? YES NO

Are customers notified when an item found out of tolerance may have resulted in the shipment of non-conforming parts? YES NO

*Control of Non-Conforming Material

Responsible Person: / Title:
Procedure: / Revision:

Are Non Conforming Material Reports generated for non-conforming material?

YES NO

Is non-conforming material, including scrapped material, suitably identified and stored to preclude accidental use? YES NO

Does the procedure identify personnel with Material Review Board authority?

YES NO We do not exercise MRB authority

Does the procedure address customer MRB requirements? YES NO

Are scrapped items rendered useless for production by permanent marking or destruction? YES NO

*Corrective Action

Responsible Person: / Title:
Procedure: / Revision:

Are Corrective Action Requests generated and acted upon in a timely manner?

YES NO

Are Root Causes adequately researched and established?

YES NO

Are Corrective Actions adequate to preclude incident recurrence?

YES NO

Is there follow-up activity to assure the Corrective Action was effective?

YES NO

Are Preventive Actions addressed? YES NO

Continuous Improvement

Do you have an active Continuous Improvement/KaizenProgram? YES NO

Internal Audit

Responsible Person: / Title:
Procedure: / Revision:

Is there a schedule? YES NO

Is it current and up to date? YES NO

Are Corrective Actions for negative findings generated and acted upon in a timely manner? YES NO

Software Control

Responsible Person: / Title:
Procedure: / Revision:

Do you use and/or develop software for use in your internal processes (including numerical control and other machine programming)?

YESNO

If yes, is the software protected to prevent unauthorized changes? YES NO

If yes, are there safeguards in place to prevent usage of improper version?

YES NO

Do you develop software for use as a stand alone or embedded product?

YES NO

If yes, have you adopted Capability Maturity Model® Integration (CMMI)?

YES NO

If yes, what level are you currently at?

Use Space below for additional comments.

ISR USE ONLY

Reviewed By: / Drop DownBernard StepnowskiRichard VerlezzaBrian OverbySteve SwicordTJ DunbarMeghan PuenteNancy Ferrell / Date:

AS9100 Verified in OASIS YES NO

Based on this limited survey the following is recommended (See Supplier Quality Database for official status of approved suppliers):

Supplier has a QMS capable of supporting ISR requirements.

Supplier has a QMS capable of supporting ISR requirements with minor deficiencies and/or major deficiencies not adversely affecting product realization.

Supplier has a QMS potentially capable of supporting ISR requirements but has major deficiencies that adversely affect product realization. These deficiencies will require rectification and subsequent re-evaluation.

This Supplier is not recommended. Supplier does not have a QMS capable of supporting ISR requirements.

In addition to the above recommendation, an on-site audit is suggested based on the nature of the commodity provided.

Approver Comments

SQE APPROVAL CHECKLIST

1 / Complete Survey Review
2 / Sign Approval Status
3 / Scan/Copy into Supplier Folder
4 / Update Supplier Database with status information (Type of Approval)

CF 1814N, WI BMS-0740-1001Page 1 of 1208/20/2012