Supplier:



|Part Name | |Plant: | |

|Part Number | |Customer Contact | |

|Date Rejected | |Phone # | |

|Quantity Rejected | |E-mail | |

|Date Opened | | |Reference Documents | |

|Date Closed | | |

STATUS: Preliminary Update Final Closed

1. TEAM MEMBERS:

|Role |Name |Title |Company |Phone |

|Champion | | | | |

|Leader | | | | |

|Team Members | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

2. PROBLEM DESCRIPTION:

|Date of Production | |

|Defect | |

|Spec. Requirement | |

|Other information | |

|Trend | 1st Occurrence | 2nd Occurrence | More than 2x |

3. CONTAINMENT:

|Date |Location |Quantity |Quantity |% Quarantined |Description |Responsibility |

| | |Sorted |Quarantined | | | |

| | | | | | | |

| |TOTAL | | | | |

3.1 HAS ALL SAFETY STOCK AT THE CUSTOMER BEEN PURGED OF DEFECTIVE MATERIALS?

|Action |Target Date or|Responsibility |

| | | |

| |Date Closed | |

| | | |

3.2 SHORT TERM CORRECTIVE ACTIONS*:

|Description |Target Date or |Responsibility |Verification |Responsibility |Target Date or |

| |Date Closed | | | |Date Closed |

| | | | | | |

4. DEFINE AND VERIFY POTENTIAL ROOT CAUSES:

| | |Target Date or| | |

|Prevent |Verification | |Responsibility |Conclusion |

|Potential Technical Root Cause | |Date Closed | | |

|T1. | | | | |

| | | | | |

| | | | | |

| | | | | |

| | |Target Date or|Responsibility |Conclusion |

|Protect |Verification | | | |

|Potential Escape Point Root Cause | |Date Closed | | |

| | | | | |

|E1. | | | | |

| | | | | |

| | | | | |

| | | | | |

| |Verification |Target Date or|Responsibility |Conclusion |

|Predict | | | | |

|Potential Systemic Root Cause | |Date Closed | | |

|S1. | | | | |

| | | | | |

| | | | | |

| | | | | |

5. & 6. DEFINE, IMPLEMENT AND VERIFY PERMANENT CORRECTIVE ACTIONS

|Prevent |Target Date or|Responsibility |Verification &Validation |Target Date or|Responsibility |

|Corrective Action - Technical Root Cause | | | | | |

| |Date Closed | | |Date Closed | |

| | | | | | |

| | | | | | |

|Protect |Date |Responsibility |Verification &Validation |Target Date or|Responsibility |

|Corrective Action - Escape Point Root Cause | | | | | |

| | | | |Date Closed | |

| | | | | | |

| | | | | | |

|Predict |Target Date or|Responsibility |Verification &Validation |Target Date or|Responsibility |

|Corrective Action - Systemic Root Cause | | | | | |

| |Date Closed | | |Date Closed | |

| | | | | | |

| | | | | | |

7. PREVENT RECURRENCE:

|Program-Specific Document / Software Update |Action(s) |Target Date or|Responsibility |

| | | | |

| | |Date Closed | |

| | | | |

| | | | |

| | | | |

|Master System |Action(s) |Target Date or|Responsibility |

| | | | |

| | |Date Closed | |

| | | | |

1. CAN THIS HAPPEN ON OTHER PROGRAMS?

|Program |Action |Target Date or|Responsibility |

| | | | |

| | |Date Closed | |

| | | | |

2. IS CUSTOMER APPROVAL REQUIRED VIA PPAP PROCESS PRIOR TO IMPLEMENTATION?

|Action |Target Date or|Responsibility |

| | | |

| |Date Closed | |

| | | |

8. CONGRATULATE TEAM MEMBERS:

Team Members Signatures: please print name clearly, then sign name

|Responsible Team Member |Name |Signature |Date Closed |

|Quality Manager | | | |

|Manufacturing | | | |

|Engineering | | | |

|Purchasing | | | |

|Other | | | |

|Other | | | |

|Evidence #1 |

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Reject #

Revision Date

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