DSCP M 4155.6 

SUBSECTION 216.2 

 OCT. 2005 * 

QUALITY HISTORY RECORDS 

DPSC Form 4275, "Report of Sampling Inspection (Attributes)" 

I. PURPOSE AND SCOPE. The purpose of this Subsection is to prescribe procedures for 

preparation of DPSC Form 4275. It is applicable to all Army Veterinary Service Personnel 

performing inspections at ration assembly plants. 

II. DEFINITION. 

 Verification Inspection/Examination. Verification Inspection/Examination by Government 

inspection personnel of items subject to Contractor Inspection: DPSCM 4155.5, SCIPM, is cited in 

the contract. 

III. BACKGROUND. When contracts cite MIL-STD-1916, Quality Assurance Representatives * 

(QARs) shall maintain a Quality History Record (QHR), DPSC Form 4275, "Report of Sampling 

Inspection (Attributes)", to facilitate administration of switching procedures and frequency of verification. 

When maintained in accordance with the following procedures, it provides a production continuity record 

on a lot-by-lot or modified skip-lot basis across contracts. 

IV. PROCEDURES. 

 A. Government Verification Inspection. Information concerning Government verification 

inspection on a lot by lot basis is transferred from the DLA Form 1714, "Product Verification 

Record" to the DPSC Form 4275, "Report of Sampling Inspection (Attributes)" (Enclosure 1). 

__________ 

This Subsection supersedes Subsection 216.2, 15 APR. 86 * 

*Denotes Changes. 
DSCP M 4155.6 

SUBSECTION 216.2 

 1. End Item - Enter nomenclature of item being inspected. 

A separate QHR shall be maintained for each item inspected. 

 2. Prime Contractor - Leave blank unless different from supplier. 

 3. Manufacturer or Supplier - Enter name and address of plant where inspection is being 

performed. 

 4. Specification Title - Enter title of the applicable standardization document (Military/Federal 

Specification, purchase description, commercial item description, etc.) used to acquire the item. 

 5. Inspection Unit - Enter the name and address of the responsible inspection activity. 

 6. Specification No. (or other standardization document) - Enter number and date of each 

applicable document. Any revision made to inspection documents while the QHR is in use shall be 

entered in the appropriate block, preceded by an asterisk (*). If space is insufficient, the "Contract 

No." block may be used. The asterisk is to identify the first lot against which the revision applies 

(see paragraph IV.A.14). 

NOTE: If the revision changes the Acceptable Quality Levels (AQLs), a new QHR shall be 

prepared. The listings for any one sampling plan of an examination shall not include more 

than one AQL. 

 7. Contract No. - Enter contract number. 

 8. Table/Paragraph of Inspection - Enter the table of examination or reference paragraph from 

the applicable standardization document for each inspection requirement. 

If there is not enough space on the form to list all tables/paragraphs (only four columns are 

available), use additional sheets as necessary. 

 9. Class of Defects - Enter each class of defects (Total, Major, Minor) for which an AQL has 

been specified for each table/paragraph of inspection listed in accordance with IV.A.8. 

 10. Acceptable Quality Level and Inspection Level - Enter each AQL designated in the 

standardization document for each table/paragraph. 
DSCP M 4155.6 

SUBSECTION 216.2 

 11. Page No. - Enter the page number of the report. Numbers shall be sequential for each 

contract and end item (e.g. 01, 02, etc.). 

 12. "From" and "To" blocks - Enter the inclusive dates of the inspections listed on each form. 

 13. SQAR's Initials - Enter initials of senior Quality Assurance Representative (QAR) after form 

has been completed and reviewed for content and accuracy. 

 14. Date - Enter the last two digits of the year in the title block, then enter in the column below 

the day and month the inspection was performed. When a revised inspection document is 

employed for the first time, enter an asterisk (*) in the margin to the left of date inspection was 

performed. 

 15. Lot number - Enter the appropriate lot number. A logical sequence shall be used within each 

contract. The Julian date, i.e., last digit of the year plus three digit number of the day of the year, 

may be used. When the Julian date is used and more than one lot is produced on any one day, 

identification is made by a hyphen and the lot sequence number, e.g., the second of two lots 

produced on 30 Dec 1985 would be 53642 and a lot produced on 

2 Jan 85 would be 5002. 

 16. No. of Pallets - Enter the number of pallets in the column below for each lot number. 

 17. No. of Cases - Enter the number of cases in each lot. 

 18. Inspection Lot Size - Enter the term in which the lot size is expressed (bags, containers, 

packets, etc.) from the table/paragraph of examination in the parenthesis in the title block, then 

enter the lot size in the column below for each lot number. 

 19. Government verification examination results shall be recorded under subheading "QAR" as 

follows: 

 a. Sample Size - Enter the number of units included in the sample for each table/paragraph of 

inspection. If double or multiple sampling plans were used, record only the total number 

of units in the sample that were examined. 

 b. Number Found - Enter the number of defects/defective units found in each sample indicated 

in 19.a. 

 c. Disposition - Enter the type of verification (A, B1 or B2) under the applicable subheading to 

indicate whether the lot was accepted (ACC) or rejected (REJ). 
DSCP M 4155.6 

SUBSECTION 216.2 

 d. Remarks - Enter the comparability results and switching procedures in accordance with 

Subsection 225.3. Due to space limitations on this form, these abbreviations shall be standardized: 

 C - comparable 

 D - doubtful 

 R - reliable 

 N - noncomparable 

 U - unreliable 

 e. Total This Page - Enter totals for each applicable column. 

 B. Contract Inspection Results. Contractor inspection results shall be recorded by the QAR under 

the subheadings "QCR" in the same manner as in paragraphs 19.a and 19.b. 

V. FORMS. The original of DPSC Form 4275 shall be retained by the QAR in accordance with the 

applicable Service regulation. Copies shall be prepared and forwarded to HQ, VETCOM, Fort Sam * 

Houston, TX 78234-6005. When requested by the Contract Quality Assurance Element (CQAE), 

additional copies will be sent to DPSC-HS. Any modification to the procedures in this Subsection shall 

be coordinated by the senior QAR with the CQAE for concurrence. 

BY ORDER OF THE COMMANDER 

Encl 

DPSC Form 4275 

 

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