Quality Assurance De

Tittle
Approved
Model
Quality Problems Report
Occurence Date

Control No.
Step Step 1 Step 2 Step 3 Step 4
Why did the problem occur ?
Why -Analysis
for recurrence
Why pass from your inspection ?
prevention

1. Phenomenon Site, number of units, condition (s) SAFETY 3. Countermeasure / Action Tentative and fibal countermeasures / number of units affected 5W1
YES NO Action for units in the market, warehouse and factory
Cause of category :
Process :

Part :

Design :

Calibration F :

Aproved Issued

Response due date : Effective date of countermeasure : PIC :

2. Cause 4. Recurrence Prevention 5W1

Dept.
Attn.

Effective date of countermeasure : PIC :

Work Process Confirm Improvement 1st

Dept Work Direction Check Sheet PFMEA
Flow: Instruction Control Chart Effectiveness Lot Confirmation
Revision OK NG OK NG
Problem found -> Fill in available information for quick information sharing -> Problem Solved -> Submit to QA by request from QA-TL -> of Documents

-> Approved, registered and distributed by AQ/Confirm effectiveness by QA or QA

Date : Date :
Quality Assurance Dept.

Approved Verified

Step 5

5W1H must be described

5W1H must be described

Dept.

Approved Verified
Date : Date :

Approved by QA Dept
 APPLICATION OF 4M CHANGE APPROVAL
Fill in by issuer/internal dept/ sub-contract

Doc No. : ........................

Model No. : ........................
Name of Dept/ Vendor/ Sub Contract
Approved Veified Reported
Date : Date : Date :
Date of Change (Plan)

Reason of change :

4M Variation Category

Man Material

Machine Method

Content of change : Attached document with this 4M :

Fill in by QA/QC and Engineering Dept

Criteria Judgement (* Please circle option)

RoHS
Dimension OK NG Appearance OK NG Reliability OK NG OK NG
Compliance

Evaluation

Accept Reject

Need Test Run

Approved Veified Evaluated
Need Test Run No Need
Date : Date : Date :
Need PHC Approval
Need No Need

4M CHANGE APPROVAL (Note : GM Approval is necessary if change not submiting for PHC/Customer approval)

GM PHC Comments
Date : Date : Sign/ Stamp :
Distribution :
PHC
PT PHC Indonesia Page :
Kawasan Industri MM2100 Blok O-1 Cikarang Barat Date :
Bekasi 17520, INDONESIA Revise :
Tel : 62-21-898-0005 / Fax : 62-21-898-1485 Doc. No :

BILLING CONFIRMATION
To : Charge To :
Company : Company :

Attn. : Attn. :
Cc : Cc :
Address : Address :

Division Code :

Dear Sir / Madam,

We would like to charge you the cost with below details :

NO DESCRIPTION/ITEM COST

TOTAL CHARGES USD -

( For detail cost please see attachment ) * ( USD, IDR, JPY )

Please sign in Approval bos for your acceptance and return back to PT PHC Indonesia by email or
Fax No : +62 21 8981485. For further queries and information, please feel free to contact us.

( CUSTOMER / SUPPLIER ) APPROVAL

Thank you for attention and cooperation.
I hereby confirmed and Approved for
Departement : all content in Billing Confirmation

Approved Reviewed Prepared Approved

Date : Date : Date : Date :

( Sign, Name and Company Chop )

Internal memo : We will pay on :
To Accounting Dept. : Please issue DEBIT NOTE for this Billing Confirmation
 Control List of Change Point

1 Part Name :
2 Part Number :
3 Company Name :
Please fill the following items for its change

2018 April July October January

1 Date of Confirmation October
2019 April July October January
Change item :
Chairman of Quality
2 Not Change Change
Assurance Compliance
Change item :
3 Design Not Change Change

Change item :
4 Material Not Change Change

Change item :
5 Dies Not Change Change

Change item :
6 Equipment/Jig/Tooling Not Change Change

Change item :
7 Production Place Not Change Change

Change item :
8 Production System Not Change Change

Change item :
9 Inspection System Not Change Change

Remark/Comment :

Note : Please report this from every 3 month on the 5th of April, July, October and January.