Part Change,

Deviation/Rework
Request for Deviation, Process Change or Rework
Number:
Process change Deviation Rework 8-D/RRCA # _________________

Part Number Part Description (as described on KAD print) Supplier Name:
Requestor Name:
Requestor Title:

Request Date:
Quantity Affected:
Cut-Off Date:

Product HOLD Required: YES NO

Delivery Affected: YES NO

Description of / Reason for Deviation, Process Change or Rework Request:

Short Term Action Required? YES NO

Person(s) Responsible: (Signature Required)

Long Term Action Required? YES NO
8-D/RRCA # _________________

Person(s) Responsible: (Signature Required)

SUPPLIER Signatures / Dates KAD Authorization Signatures / Dates

Engineering: Engineering:

Quality: Quality:

Manfacturing: Manufacturing:

Materials: Other:

Marketing: DISPOSITION
Program Mgt.: Rework Quantity:

QAF.0044
QI 7.4.3.1
Rev B
Management: Repair Quantity:

Other: Scrap Quantity:

QAF.0044
QI 7.4.3.1
Rev B
 Part Change,
KAD Supplier ID Number -
Deviation/Rework Sequential Number
Request for Deviation, Process Change or Rework Number:
Process change Deviation Rework Supplier Company Name
8-D/RRCA # _________________
Part Number Part Description (as described on KAD print) Supplier Name:
Requestor Name: Name & Title of Person Requesting
Requestor Title: Deviation
KAD
KAD Part Drawing Request Date: Date Deviation Form is Initiated
Numbers Part
Covered Description Quantity Affected:
With This Quantity Covered With This
From the
Deviation Cut-Off Date: Deviation & Deviation End Date
Drawing
Title Block
Product HOLD Required: YES NO

Delivery Affected: YES NO

Description of / Reason for Deviation, Process Change or Rework Request: Note If You Will Initiate A
Product Hold For This Non-
Describe Why You Are Asking For This Note If You Expect This Defective conforming Condition or Not
Deviation, process change or Rework. Condition to Affect KAD's
Clearly Note How the Parts Do Not Meet Expected Delivery of This Part
The Drawing Specification, or why rework is Number(s)
necessary

Short Term Action Required? YES NO

Description of Short Term Action
Indicate if Short Term Required to Protect Shipments in
Actions are Required This Area
to Protect Shipments
Signature of Whoever will be Responsible for
These Short Term Activities

Person(s) Responsible: (Signature Required)

Long Term Action Required? YES NO 8-D/RRCA # _________________

Your 8-D / RRCA # to Description of Long

Indicate if Long Term support prevention Term Action Required
Actions are Required to activities to Protect Shipments
Protect Shipments in This Area
pending implementation
of RRCA Action Plans Signature of Whoever will be Responsible for
These Long Term Activities

Person(s) Responsible: (Signature Required)

SUPPLIER Signatures / Dates KAD Authorization Signatures / Dates

Engineering: Engineering:
KAD Signatures & Dates
Quality: Quality: Indicate the REQUIRED
Signatures and Approval of this Deviation
Manfacturing: Manufacturing: Request.
Dates of Those
Materials: Making and Other:
Supporting This
Marketing: Deviation DISPOSITION
Request.
Program Mgt.: Rework Quantity: This Area Is Used To
Document Your Actual
Results for This Activity
QAF.0044
QI 7.4.3.1
Rev A
 Deviation
Request.
This Area Is Used To
Document Your Actual
Management: Repair Quantity:
Results for This Activity
Other: Scrap Quantity:

QAF.0044
QI 7.4.3.1
Rev A
QAF.0044
QI 7.4.3.1
Rev A