/ 805 Housatonice Ave.
Bridgeport, CT06604
Phone 203-367-6910
Fax 203-367-6975

Supplier Quality Questionnaire

Company Name
Street Address
City / State / Zip Code
Phone No. / Fax No. / Cage Code
Website Address
Facility / Total Area (Sq Ft) / Total Employees / Current Capacity %
Scope of Approval
OrProduct/Service Produced
Departments / Name / Title / E-mail Address
Quality Control
Manufacturing
Sales
Who is the responsible contact for the quality management system (i.e. inspection records, certs, and calibration)?

Quality Control System/Program:

Quality Standard / Revision / Expiration Date
/ AS9100
/ ISO13485
/ ISO9001
/ FAR 52-246.2
/ ASQR-01
/ Other
  1. Do you comply per Environment, Health & Safety regulations?YESNO
  2. Do you have Flight Safety Program?YESNO

Check below if approved by any of the following:YESNO

Sikorsky AircraftPWABoeingDefenseOther

  1. Is your quality management system/program certified? YESNO

If YES, please provide evidence of registration certificate. There is no need to complete the remainder of the questionnaire. Please sign and return this page. If your quality system is not certified, please fill out the remainder of questionnaire.

Print Name & Title / Signature / Date
Supplier Quality Questionnaire
1. Is there a written Quality Control Manual? Standard written against? / Yes / No
Please state specification number (9001:2008, AS9100C, ISO 14385, etc.): ______
2. Do you audit your quality program? / Yes / No
3. How often is the program audited? ______
4. Who conducts the quality audit? ______
5. Do you allow customers to perform on-site audits, if required? / Yes / No
6. Do you ensure that the correct drawings, specifications, documents, and procedures are used? / Yes / No
7. Do you provide a Certificate of Conformance attesting that your product meets all requirements of
the purchase order? / Yes / No
8. Will you seek Delta-Ray Industries approval prior to shipping product that deviates from purchase
order/ drawing requirements? / Yes / No
9. Will you notify Delta-Ray Industries in advance if delivery dates cannot be met? / Yes / No
10. Do you maintain quality-related documents for your products? / Yes / No
11. How long do you maintain records that pertain to a PO (material certificates, inspection reports, etc.)? / ______
12. Do you maintain a Corrective Action system with your suppliers? / Yes / No
13. Do you take responsibility for work performed by your suppliers? / Yes / No
14. Do you have the capability to trace a product back to the raw material, if required? / Yes / No
15. Do you have a program to ensure that inspection gages, measuring devices, and test equipment are
calibrated to recognized standards and at specified intervals? / Yes / No
16. Do you ensure that the personnel are sufficiently trained and qualified to perform their job function? / Yes / No
17. Do employees use documented procedures and/or work instructions for operations that have a direct
influence on product/process quality? / Yes / No
18. Do you have a controlled method for issuing stock to production or sales? / Yes / No
19. Are materials properly stored to prevent damage, corrosion, or general degradation? / Yes / No
20. For products with shelf lives, do you ensure that they are not used past their shelf lives? / Yes / No
21. Can you ensure that materials, fixtures, or equipment provided to you by Delta-Ray Industries will
be properly stored, maintained, and returned? / Yes / No
22. Do you ensure that products are properly packaged for shipping? / Yes / No
23. Do you take responsibility for damage during shipping due to improper packaging? / Yes / No
Survey Completed By:Signature:
Name & Title: / Date:
For DELTA-RAY USE ONLY
Reviewed By:
Date: / Comments:

Form No. 7.4-1 Rev.C2/18/14 Page 1 of 2