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Supplier Quality System Report

We won’t share your info with anyone else.

We must have a completed copy of this survey on file prior to acceptance of any product. Please complete this form and return it, as soon as
possible, to the address below, via fax, or by email. We thank you for your time and input.

Section 1: Supplier Information
Supplier Name*
Date*
MM slash DD slash YYYY
Company Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Fax
Section 2: Key Management
Name*
First Last
Title*
Name
First Last
Title
Name
First Last
Title
Section 3: Supplier Scope (Capabilities)
Please select your scope / capabilities.*
- Raw Material
- Finished Goods
- Hardware & Assembly
- Prime/Paint
- Distributor
- Calibration
- Metrology
- Other
Section 4: 3rd Party Quality System Certifications - Please provide a copy of each certificate or letter of approval
ISO 9001
Accepted file types: jpg, jpeg, pdf, png, doc, docx, Max. file size: 256 MB.
Mil Std 45662A
Accepted file types: jpg, jpeg, pdf, png, doc, docx, Max. file size: 256 MB.
AS9100
Accepted file types: jpg, jpeg, pdf, png, doc, docx, Max. file size: 256 MB.
ISO 10012-1
Accepted file types: jpg, jpeg, pdf, png, doc, docx, Max. file size: 256 MB.
Other
Accepted file types: jpg, jpeg, pdf, png, doc, docx, Max. file size: 256 MB.
Is your company ISO 9001 or AS9100 certified?*
- Yes
- No
I certify that the information provided on this report is accurate as stated.
Name*
First Last
Title*
Signature*
Date*
MM slash DD slash YYYY
Section 5: Quality System Questions
Do you have an independent quality organization?*
- Yes
- No
- N/A
Do you have a documented quality system?*
- Yes
- No
- N/A
Do you have a formal supplier evaluation process?*
- Yes
- No
- N/A
Do you monitor your supplier's performance?*
- Yes
- No
- N/A
Do you allow customers to perform quality audits of your facility/process?*
- Yes
- No
- N/A
Do you have a documented corrective action process?*
- Yes
- No
- N/A
Do you have a customer complaint process?*
- Yes
- No
- N/A
Do you have a documented nonconforming material control process?*
- Yes
- No
- N/A
Do you perform in-process inspection/verification?*
- Yes
- No
- N/A
Do you perform final inspection/testing prior to delivery?*
- Yes
- No
- N/A
Do you periodically calibrate test/measuring equipment?*
- Yes
- No
- N/A
Do you retain records of quality activities?*
- Yes
- No
- N/A
Do you perform internal audits?*
- Yes
- No
- N/A
Do you have an employee training program?*
- Yes
- No
- N/A
Do you use statistical techniques or inspection sampling?*
- Yes
- No
- N/A
Non-conforming product: The supplier is to notify Superior Plastics for disposition of any non-conforming product within a reasonable time period after it is identified.

Disposition: The supplier is to obtain Superior Plastics approval for non-conforming product disposition.

Supplier change of process: The supplier is required to notify Superior Plastics of any changes in product and/or process, changes of suppliers, changes of manufacturing facility location, and where required, obtain Superior Plastics approval.

Flow down requirements: Suppliers are required to flow down to the supply chain Superior Plastics requirements, including customer requirements.

Records retention: Supplier is responsible for maintaining all records pertaining to Superior Plastics for a minimum of seven (7) years.

Right to access: Superior Plastics, their customer, and any regulatory authorities will have the right of access to all supplier facilities and applicable records, at any level of the supply chain, involved in fabrication or process of any purchase order issued by Superior Plastics.

Supplier must provide OEM certificate of compliance and test reports upon request
Supplier Acknowledgement*
Date*
MM slash DD slash YYYY
Company Name*

SUPERIOR PLASTICS USE ONLY
Supplier Risk Assessment:	Approval Status:	Approved By:
□ Low □ Medium □ High	□ Approved □ Disapproved □ Conditional	Signature: Title: Date:
Remarks:




Means of Approval: (select all that apply)
□ Supplier Questionnaire □ Certification □ Customer Directed □ Previous Buisiness	□ Customer Quality System Evaluation □ On-Site Audit □ Sole Source □ Other
SUPERIOR PLASTICS USE ONLY

Rev 3/4/2013
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2412 Chester St.
Fort Worth, Texas 76103
Phone: (817) 882-9595
Fax: (817) 332-6272

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