Format No.

: 10-QUA-15 F01
Rev. No. : 01
Eff. Date : 01.12.2019
SECTION CODE -YEAR-MONTH-SR No.

Registration No.
MASS PRODUCTION
Supplier In-house
Deviation Request Date Initiated

Initiator Department Signature

Process Location HOD Sign.

Start Date End Date No. of Pieces

(Required) 90 calendar day max. (Optional)

Model(s) Affected Plants Affected Cost Impact

ECI
Part Number Part Name
Level

SPECIAL CHARACTERISTICS (IF ANY)　S▽、Ａ◇、Ｊ◇、Ｒ▽ □Yes □No

Description

Countermeasure Plan

Reason

Use parts that do not meet engineering drawing specifications Temporarily unable to follow Instructions

Material substitution (Describe in Comments/Special Instructions) Unable to run machine within specified parameters

Unable to do process control defined on the control plan Setting up a temporary rework operation

Use parts that do not meet approved appearance standards Continuation of non-capable process

Use parts in production prior to Supplier Part Submission Incomplete parts must be stored in the finished part
approval container

Sample parts are being built on a line that runs current Adding requirement for 100% inspection of parts
production parts (short-term)

Other

Comments/Special Instructions

Approval
MANUFACTURING PE / MAIN / DIE MAIN. PPC / LOGISTICS ASSY / PRESS ENGINEERING
1

Date: Date: Date: Date: Date:

ACCEPT REJECT ACCEPT REJECT ACCEPT REJECT ACCEPT REJECT ACCEPT REJECT
If Reject (Comment):

Quality Assurance (Final Approval) QUALITY ASSURANCE

ACCEPT
Comment : REJECT

CUSTOMER APPROVAL REQUIRE:

1 (YES / NO) Date:

Extension Extension till Extension of DR approved through (Dept):

Requester
HOD Quality

Closure Confirmation

Plant Name