SUPPLIER QUALIFICATION AND APPROVAL FORM
SUPPLIER QUESTIONAIRE
Supplier Information
Supplier Name
Address

Website
State

Zip

Phone

Fax

Contacts
President/Owner

E-mailOperations Manager

E-mail

Quotations

E-mailExpediting

E-mailQualityE-mail

Accounting

E-mailEngineering

E-mailPurchasing / Materials

E-mailSales

E-mailBusiness Information
Type of business ownership: _______________________________________________________
Products and/or Services Supplier Provides:__________________________________________________________________________________
Attach Supplier capability listing or line card to this form.
Number of years in business: _____________

Number of shifts run? ______________________

Number of Employees: __________________

Building Square Footage? ____________________

Annual employee turnover:[ ] <1%[ ] 1-5%[ ] 6-10%[ ] 11-20%[ ] >20%

Suppliers current annual Sales: Year____________ $ _______________________________________
Suppliers projected Sales Growth in the next year? $__________ 2 yrs: $_________ 5 yrs: $_________
Form 3-14-25-001 Rev 3
Page 1 of 10

Largest Customers
1. Company Name: __________________________________________________________________
Percentage of Sales: % ___________________

Industry __________________________

Contact that may be called on: ________________________ Phone Number: __________________
2. Company Name: __________________________________________________________________
Percentage of Sales: % ___________________

Industry __________________________

Contact that may be called on: ________________________ Phone Number: __________________

GeneralWhat is Supplier’s typical planned capacity utilization? %________________________________
Capital Equipment Re-investment in %:Last year______________ Next Year_____________

Human Resources investment in %:Last year______________ Next Year_____________

Percentage of complete work that is Sub-contracted %___________________________________
Supplier has insurance covering sub-contractors or requires sub-contractor to carry insurance covering Raw Material,
WIP, and Finished Goods? _____________________________________________________________________________

Customer Service
Supplier provides value added sub-assembly capabilities? ________________________________
Supplier can read electronic files of engineering prints? Solid Works, etc. (Circle file types that are applicable or list
additional types)_________________________________________________________________________________________
Supplier utilizes a formal customer design review process?

No

Yes

Supplier’s on time delivery to all customers is? % _____________________________________
Supplier’s percentage of customer returns is? % _____________________________________
Supplier’s typical quotation turnaround time is?

______________ Days

General lead times for; Prototype __________________ Production ______________________
Production Tooling _____________________________________________________________
Supplier is familiar with and utilizing demand pull delivery systems (Kanban)? _______________
Supplier is using bar-coding technology? ____________________________________________
Page 2 of 10

Form 3-14-25-001 Rev 3

FACILITY PROFILE

Yes

No

Comments

Is the facility registered with the FDA?
If yes, registration number:
If yes, date of last inspection by the FDA:
Were there any findings during the audit?
If yes, were recalls involved?
If yes, what was recalled?
Is the facility in compliance with RoHS guidelines?
If yes, provide accompanying documentation. Approved
RoHS material declaration documents include:-

IPC-1752 Materials Declaration-

Raw Material Data Sheet (RMDS)-

Laboratory Analysis Report (LAR)-

X-Ray Fluorescence Analysis Report (XRF)-

Manufacturer’s published data sheet indicating RoHS
Compliance (MPDS)-

Part Assembly RoHS Certification (PARC)

Do your products contain BPA, DEHP?
- Please provide declaration / statement on BHA/DEHP
Do your products contain latex?
- Please provide declaration / statement on latex
Is the facility ISO certified?
If yes, certification number and certificate copy
List other special certifications:

If ISO Certified, stop here skip to last page to complete.
(PLEASE REMEMBER TO INCLUDE A COPY OF YOUR ISO CERTIFICATE(S))

Page 3 of 10

Form 3-14-25-001 Rev 3

A
1
2
3
4
5
6
7

B

MANAGEMENT RESPONSIBILITY

DOCUMENT CONTROLIs there a formal Change Control System?

5
6

Is their documented record retention policy?

NEW PRODUCT DEVELOPMENT

45

Are process capability studies performed?

6

Are quality costs analyzed when evaluating proposed changes tomethods, materials, personnel, and equipment?

2
3

No

Procedure
NumberComments

Yes

No

Procedure
NumberComments

Is a system in effect to control customer furnished specifications?

Is there a formal design control process and team for new
products?
In the pre-production process, are quality characteristics selected
for a product based on their relative importance?
Are potential sources of manufacturing problems and control ofquality problems identified and eliminated prior to start ofmanufacture?
Are revised specifications reviewed prior to acceptance?

1

Yes

Is there revision control to ensure the current document status?
Are the latest specifications available at the manufacturinglocation?
Are records maintained?

C

Comments

Is there a system to capture and analyze quality costs?

2

7

Procedure
NumberDo personnel performing the quality function have theresponsibility and freedom of action to identify, quarantine andevaluate quality problems?
Does company management approve a documented Quality
Manual?
Are personnel performing the quality function trained in theprocedures, instructions and methods identified in the quality
manual?
Is there a system providing for training all personnel regarding
quality philosophies?

Is there a formal Document Control System?

4No

Is there an organization chart that identifies elements responsiblefor quality efforts? If yes, please provide a copy.
Is there a formal Quality Control/Assurance department?

1

3

Yes

Page 4 of 10

Form 3-14-25-001 Rev 3

D
1

2

3

4

5

E
1
2
3
4

F
1
2
3

PURCHASING

Procedure
NumberComments

Yes

No

Procedure
NumberComments

Yes

No

Procedure
NumberComments

Are there controls to ensure that purchased materials meetrequirements such as:- Receipt of statistical data verifying conformance tospecifications?
- Receipt of Certificates of Analysis or Compliance?
- Receiving inspections or tests?
Is corrective action related to supplier products prompt andeffective?
Is there an effort to know and understand supplier’s quality
systems through the use of:- Periodic audits performed at source locations?
- Supplier rating system?
Supplier qualification program?
Will Suppliers agree to not change materials or design without
notice to GC?

PRODUCT IDENTIFICATION
Are there procedures that ensure adequate product identification?
Is the status of all products clearly identified?
Is product traceability maintained throughout all phases ofmanufacturing?
Does product identification provide traceability to individuals
performing inspection?

PROCESS CONTROLIs product produced following documented instructions or control
plan?
Are documents containing specific manufacturing and inspection
instructions available and utilized during production?
Are process adjustment and shutdown limits clearly established?
Is product traceability maintained throughout production?

5

Do Supplier have a formal, documented environmental control
system?

7

No

Are product requirements clearly identified on Purchase Orders?

4

6

Yes

If yes, what level of cleanliness is maintained in production?
Are GMP policies enforced in the manufacturing areas?

8

Can traceability be maintained throughout the manufacturing
process?

9

Are there documented housekeeping and pest control
procedures?
Page 5 of 10

Form 3-14-25-001 Rev 3

10

Are manufacturing processes documented?

11

Are manufacturing processes validated?

12

Are there written procedures for packaging and labeling?

G

IN-PROCESS INSPECTION

4

Are in-process inspections performed per documented
instructions?
Is product inspected, measured or tested after process set-up andafter process changes to ensure that product consistently meetsrequirements?
Is product inspected, measured or tested during processing toassure continuous conformance to requirements?
Is sampling performed per documented sample plans?

H

RECEIVING INSPECTION

1
2
3

4

Is product inspected to ensure conformance to requirements prior
to production use?
Is product that has been accepted on the basis of test reports orcertificates subjected to periodic verification?
Is product pending inspection, accepted product andnonconforming product identified and segregated?
Is sampling performed per documented sample plans?

5

Is there a sample retention policy?

1
2
3

I
1
2
3
4

J
1

FINAL INSPECTION

Yes

No

Procedure
NumberComments

Yes

No

Procedure
NumberComments

Yes

No

Procedure
NumberComments

Yes

No

Procedure
NumberComments

Is sampling performed per documented sample plans?
Are there documented procedures for use during inspection, test
and measuring which include reference to visual aids, sample
plans and equipment?
Are there documented procedures to assure that nonconforming
product is clearly identified and segregated?
Is responsibility and authority for final disposition of
nonconforming product defined?

INSPECTION, MEASURING AND TEST EQUIPMENTIs there a system in effect for calibrating inspection, measuring,and test equipment used to verify product conformance torequirements?
Page 6 of 10

Form 3-14-25-001 Rev 3

2

Are inspection, measuring and test equipment identified to show:- Date calibrated and calibration due date?
- Person who performed calibration?
- Device identification?

3

Are calibration records maintained?

4

5
6
7
8

Do calibration records reflect:- Device identification?
- Calibration method?
- Master Standard reference?
- Calibration date?
- Calibration frequency?
- Person who performed calibration?
- Deviation from standard?
- Acceptance criteria?
- Corrective action on device found to be out of calibration?
Is there a system to validate product inspected, measured or tested
during the time a device was found out of calibration?
Is inspection, measuring and test equipment identified andremoved from the system when found out of calibration?
Are standards calibrated with certified masters traceable to the
National Institute of Standards and Technology (NIST) or its
international equivalent?
Are laboratory reagents and other chemicals identified and tested?

9

Is preventive maintenance performed on production equipment?

10

Are maintenance and service records available for production
equipment?

K
1
2
3
4
5
6
7
8

Yes

CORRECTIVE ACTION

No

Procedure
NumberComments

Is there a corrective action system in place that provides forprompt identification and correction of conditions adverse to
product quality?
Is non-conforming product data analyzed to determine cause andextent of quality problems?
Is the responsibility and authority for final implementation ofcorrective action defined?
Is follow-up action performed to verify the effectiveness ofcorrective action?
Are customers notified when non-conforming product may havebeen inadvertently shipped?
Do corrective action activities emphasize prevention?
Are suppliers required to meet or exceed internal corrective action
requirements?
Is there a system to handle customer rejected or returned goods
that includes reporting corrective and preventative action to thecustomer?
Page 7 of 10

Form 3-14-25-001 Rev 3

L

PRODUCT STORAGE, HANDLING, PACKAGING,
DELIVERY3

Are storage facilities adequate to safeguard product from damage,contamination or loss?
Is there a system for handling product to prevent damage,contamination, or loss?
Is status of all products clearly identified?

4

Are product storage areas restricted to authorized personnel?

125Is there a stock rotation system?

7

Are procedures in place covering packaging, shipping?

9

M

RECORDS

3N

INTERNAL AUDITS

2

1

2

3
4
5

Procedure
NumberComments

Yes

No

Procedure
NumberComments

Yes

No

Procedure
NumberComments

Do procedures meet appropriate government agency guidelines(DOT or EPA for example)?
Are procedures in place to ensure that containers and bulk trailers
are clean prior to filling?

Is there a documented policy for identifying and maintaining quality
records?
Do quality records identify:- Characteristics to be measured?
- Number and description of non-conformities?
- Acceptance criteria?
- Reference the action taken?
- Disposition of inspected material?
- Inspector identification?
- Date of inspection?
Is there a system to assure review of quality records?

1

No

Is product traceability maintained during storage and handling?

6

8

Yes

Is there an internal audit system in place for assessing effectivenessof the quality system and to assess compliance with documented
procedures and instructions?
Do internal audits include the evaluation of activities, processes,
work areas, services, and systems as well as written procedures,instructions and other quality system documentation?
Is responsibility for the internal audit system independent from theresponsibility for the performance of manufacturing and quality
functions?
Are timely corrective actions taken on audit non-conformances?
Are internal auditors trained?

Page 8 of 10

Form 3-14-25-001 Rev 3

O
1
2

STATISTICAL PROCESS CONTROL

4
5

Are critical quality characteristics predictably distributed?

6
7
8

No

Procedure
NumberComments

Are appropriate means used to determine whether processes arein statistical control, using critical quality characteristics?
Is there evidence that critical quality characteristics are used todetermine whether processes continue to be in statistical control?
Is corrective action taken on processes found to be out ofstatistical control?
Are process capability studies performed and utilized?

3

Yes

Is a system in place to reduce inherent variability or move theprocess average to target?
Is inspection, measuring and test equipment analyzed forcapability, precision and accuracy prior to purchase and use?
Is there a system to correlate internal inspection, measuring andtest equipment with customer results?

GENERAL NOTES OR COMMENTS:

COMPLETED BY:__________________________________________________________

Date: _____________________TITLE:______________________________________________________________________________________________

Page 9 of 10

Form 3-14-25-001 Rev 3

For Graphic Controls use only:

PURCHASING

Critical Supplier?

[ ] Yes[ ] NoSupplier Scorecard?

[ ] Yes[ ] No[ ] Approved

Comments[ ] Rejected
Name

Signature

Date

ENGINEERING
Required on Critical Suppliers only

[ ] Approved

Comments[ ] Rejected
Name

Signature

Date

QUALITY
1st Article?
Part Qualification?

[ ] Yes [ ] No
[ ] Yes [ ] No

Required on Critical Suppliers only

[ ] Approved

Comments[ ] Rejected
Name

Signature

Page 10 of 10

Date

Form 3-14-25-001 Rev 3