Cover Sheet
Sender / Recipient / Production Process and Product Approval / submit level:
Report for Other Samples / Re-Sampling
Sampling / Production stopped for
New Part / more than 12 months
Product Change (Specification Change): / Change of supplierchain
Change of Production Process:
Enclosures / Documents to be Reviewed
Produkt/ Prozess
1.1 Verification of Dimensions / 1.7Reliability Testing / 7 Material data sheet / 13Tool overview
1.2 Functional Testing / 2 Samples / 8 Software test report / 14 Process Capability Study
1.3 Material Testing / 3 Technical specifications / 9 Process – FMEA / 15Self assessment matrix
1.4Sound Testing / 4 Product – FMEA / 10Production Control Plan / 16Transport unit / packing
1.5Surface Testing / 5 Design Approval / 11 Hedgingpredetermined characteristics / 17 PPF status supply chain
1.6 ESD – Testing / 6 Comply with legal requirements / 12Measuring system analysis / 18 Others
Supplier information
Supplier/Production location: / Heraeus supplier No.: / Customer:
Designation: / Shipment-No.: / Report-No.:
Part Number: / Quantity: / Receipt-No./ -date:
Drawing Number: / Lot Number: / Order-No./ -date:
Status / Date: / Weight of Sample: / Shipment address:
Confirmation from Supplier – We herewith confirm, that the sampling process beased the requirements of VDA volume 2.
Name: / Department: / Phone: / Fax / E-mail:
Remark:
Date: / Signature:
Customer Decision / Individual Approval:
Product/ Process
Total / TotalProcess / Total Product / 1.1 / 1.2 / 1.3 / 1.4 / 1.5 / 1.6 / 1.7 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 / 13 / 14 / 15 / 16 / 17 / 18
Approved
Conditional approval, Re-Sampling required
Refused, New Sampling required
Deviation Approval-No.: / Valid until:: / Quantity: / Date for Re-Sampling: / If sent back, Delivery-Note-No. / -Date:
Name: / Phone:
Department: / Fax/ E-mail:
Remark: / Datum / Unterschrift
Distribution to: / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11
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Supplier / Production Location: / Customer:
Heraeus supplier No.: / Code No.:
Report No.: Index: / Report No.: Index:
to be filled in by customer
Designation: / Drawing Number:
Part Number: / Status /Date:
Enclosure / Status / Date / Type, No. of Pages,Identification of Enclosures
1.1 Verification of Dimensions
1.2 Functional Testing
1.3 Material Testing
1.4Sound Testing
1.5Surface Testing
1.6 ESD – Testing
1.7Reliability Testing
2 Samples
3 Technical specifications
4 Product – FMEA
5 Design Approval
6 Comply with legal requirements
7 Material data sheet
8 Software test report
9 Process – FMEA
10Production Control Plan
11 Hedgingpredetermined characteristics
12Measuring system analysis
13Tool overview
14 Process Capability Study
15Self assessment matrix
16Transport unit / packing
17 PPF status supply chain
18 Others
Remarks from Supplier:
Name:
Department:
Phonf:
Fax:
E-mail:
Date: / Signature:
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Product related Test ResultsStatus: / Date:

1.1 Verification of Dimensions / 2 Samples
1.2 Functional Testing / 3 Technical specifications
1.3 Material Testing / 4 Product – FMEA
1.4Sound Testing / 5 Design Approval
1.5Surface Testing / 6 Comply with legal requirements
1.6 ESD – Testing / 7 Material data sheet
1.7Reliability Testing / 8 Software test report
Supplier / Production Location: / Customer:
Heraeus supplier No.: / Code Numer:
Report No.: Index: / Report No.: Index:
to be filled in by Customer
Designation: / Designation:
Part Number: / Part Number:
Drawing Number: / Drawing Number:
Status/Date: / Status/Date:
Ref.No.: / Requirement
Specification / Actual Values (Supplier) / Specification fullfilled / Remark
yes / no
Confirmation from Supplier: / Customer Decision:
Remarks: / Approves
Conditional approval, Re-Sampling required
Refused, New Sampling required
Bemerkungen:
Name:
Department:
Phone:
Fax:
E-mail: / Name:
Department:
Phone:
Fax:
E-mail:
Date: / Signature: / Date: / Signature:
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Process related and other DocumentsStatus: / Date:

9 Process – FMEA / 14 Process Capability Study
10Production Control Plan / 15Self assessment matrix
11 Hedgingpredetermined characteristics / 16Transport unit / packing
12Measuring system analysis / 17 PPF status supply chain
13Tool overview / 18 Others
Supplier / Production Location: / Customer:
Heraeus supplier No.: / Code Numer:
Report No.: Index: / Report No.: Index:
to be filled in by Customer
Designation: / Designation:
Part Number: / Part Number:
Drawing Number: / Drawing Number:
Status/Date: / Status/Date:
Confirmation from Supplier: / Customer Decision:
Remarks: / Approves
Conditional approval, Re-Sampling required
Refused, New Sampling required
Bemerkungen:
Name:
Department:
Phone:
Fax:
E-mail: / Name:
Department:
Phone:
Fax:
E-mail:
Date: / Signature: / Date: / Signature:
HNG_F_PPF
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