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PO Number 456
Customer Part Number 234
Customer Name/Division CustName
Customer Contact ContactName
Buyer/Buyer Code 789
Street Address 123 Street
City City
Region ST
Postal Code 12345
Country USA
Sheets
Characteristics List
Part Submission Warrant
Truck Submission Warrant
Appearance Approval
Dimensional Results
Material Test Results
Performance Test Results
Bulk Materials Requirements
Design Matrix
Product-Process Change
Control Plan
PFMEA
Process Flow Diagram
Inspection Report
Appearance Approval Ford-GM
Appearance Approval - Chrysler
Supplier Checklist
Supplier Request
Interim Recover Worksheet
Engineering Source Approval
Bulk Materials Interim Approval
Process Matrix
PQP Summary
Data Points Coordinates
Team Feasibility Commitment
8-D Report
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May NOT use this template to perform their own analysis without a license
To purchase a license:
http://www.qimacros.com/products.php
Email orders@qimacros.com
Call 888 468 1537
Fax a PO to 888 468 1536
Safety and/or Government Regulation __ Yes __ No Purchase Order No. 456 Weight kg
MATERIALS REPORTING
Has customer-required Substances of Concern information been reported Yes No n/a
Are polymeric parts identified with appropriate ISO marking codes Yes No n/a
SUBMISSION RESULTS
The results for __ dimensional measurements __ material and functional tests __ appearance criteria __ statistical process package
These results meet all drawing and specification requirements; __ Yes __ NO (If "NO" - Explanation Required)
Mold / Cavity / Production Process
DECLARATION
I hereby affirm that the samples represented by this warrant are representative of our parts, which were made by a process that meets all Production Part
Approval Process Manual 4th Edition Requirements. I further affirm that these samples were produced at thed production rate of ____ / ___ hours.
I also certify that documented evidence of such compliance is on file and available for review. I have noted any deviations from this declaration below.
EXPLANATION/COMMENTS:
Title Email
Engineering Drawing
Tool PO Number 456 Change Level 0 Dated
Note: Does this part contain any restricted or reportable substances? Yes No
Are plastic parts indentified with appropriate ISO marking codes? Yes No
DECLARATION
I affirm that the samples represented by this warrant are representative of our parts, and have been made to the applicable customer
drawings and specifications and are made from specified materials on regular production tooling with no operations other than the regular
production process. I also certify that documented evidence of such compliance is on file and available for review.
EXPLANATION/COMMENTS:
Title Email
APPEARANCE EVALUATION
Authorized Customer
Organization Sourcing and Texture Information Pre-texture Representative
Evaluation Signature and Date
Correct and
Proceed
Correct and
Resubmit
Approved to
Etch/Tool/EDM
COLOR EVALUATION
Color
Color Tristimulus Data Master Master Material Material Hue Value Chroma Gloss Metallic Shipping Part
Suffix Number Date Type Source Brilliance Suffix Disposition
DL* Da* Db* DE* CMC Red Yel Grn Blu Light Dark Gray CleanHigh Low High Low
Comments
1 0.603-0.625 inches
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Not
OK OK
Date
0.603-0.625 inches
0.603-0.625 inches
Not
OK
Low/Acceptable Odor
Low/Acceptable VOC
Good Hiding Latitude
Good Shelf StabilIty
PROCESSABlLITY
ENVIRONMENTAL
Good Color Match
CATEGORY/ CHARACTERISTICS
PERFORMANCE
HAPS Compliant
Stable Rheology
No Telegraphing
No Mudcracklng
Dirt / Seed Free
APPEARANCE
No Edge Pull
No Pinholing
Crater Free
Failure
Units
Formula Ingredients
ResinA under 40 UNITS
over 50 "
ResinB under 50 Binder Solids
over 35 "
Crossllnker under 20 Binder Solids
over 30 "
SP Rheology Control Additive under 0.5 Total Solids
over 2.5 "
Color Dispersion - B under 1 Total Solids
over 2 "
Solvent D under 5 Formula Wgt
over 15 "
Alcohol Solvent under 2 Formula Wgt
under 4 "
Ingredient Characteristics
Resin A Viscosity under 30 Poise (#1 @ 50)
over 40 "
SP Chrosslinker Imino under 1 %Molar Comp
over 10 "
Product Characteristics
SP Viscosity under 30 sec #4 Ford Cup
over 40 sec "
SP % NV Solids under 57 % N.V. @ 110 C
over 61 "
Resistivity under 0.01 megaohms
over 0.15 "
Process Constraints
Batch Mixing Temp over 70 F
under 110 "
Conditions for Use
Flash Time before clear under 1 Minutes
over 3 "
SP Final Bake Temp over 250 F
under 275 "
Complete this form and email to your customer organization whenever customer notification is required by the PPAP
Manual in Table 3.1. Your customer will respond back with an acknowledgement and may request additional change
clarification or PPAP submission requirements.
To: Customer:
Organization Part Number: 123 Engineering Revision Level Revision Cod Dated:
Customer Part Number: 234 Engineering Revision Level Revision Cod Dated:
Application:
Name: Title:
Business Phone No: Fax No:
E-Mail: Date:
Note: Please submit this notification at least 6 weeks prior to the planned change implementation !
Contact your customer to determine if this form is available in an electronic format or if this form should be faxed.
Supplier/Plant CitySt Supplier Code 123 Other Approval/Date (If Req'd) Other Approval/Date
Characteristics Methods
Part/ Process Name/ Machine, Device, Jig, No. Product Process Special Product/Process Evaluation/ Size Freq. Control Reaction Plan
Process Operation Tools, for Mfg. Char Specification/ Measurement Method
Number Description Class Tolerance Technique
1 1 0.603-0.625 inches
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
14 14
15 15
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 23
24 24
25 25
26 26
27 27
28 28
29 29
30 30
31 31
32 32
33 33
34 34
35 35
Revision Code 0.0
http://www.aiag.org/ CONTROL PLAN Page 26 of 61
Prototype Prelaunch Production Key Contact/Phone Date(Orig) Date (Rev.)
Control Plan Number 1
Part Number/Latest Change Level 123 Core Team CoreTeam Customer Eng. Approval/Date
Supplier/Plant CitySt Supplier Code 123 Other Approval/Date (If Req'd) Other Approval/Date
Characteristics Methods
Part/ Process Name/ Machine, Device, Jig, No. Product Process Special Product/Process Evaluation/ Size Freq. Control Reaction Plan
Process Operation Tools, for Mfg. Char Specification/ Measurement Method
Number Description Class Tolerance Technique
36 36
37 37
38 38
39 39
40 40
41 41
42 42
43 43
44 44
45 45
46 46
Supplier/Plant CitySt Supplier Code 123 Other Approval/Date (If Req'd) Other Approval/Date
Characteristics Methods
Part/ Process Name/ Machine, Device, Jig, No. Product Process Special Product/Process Evaluation/ Size Freq. Control Reaction Plan
Process Operation Tools, for Mfg. Char Specification/ Measurement Method
Number Description Class Tolerance Technique
Supplier/Plant CitySt Supplier Code 123 Other Approval/Date (If Req'd) Other Approval/Date
Characteristics Methods
Part/ Process Name/ Machine, Device, Jig, No. Product Process Special Product/Process Evaluation/ Size Freq. Control Reaction Plan
Process Operation Tools, for Mfg. Char Specification/ Measurement Method
Number Description Class Tolerance Technique
Occurrence
Occurrence
Detection
Detection
Potential Current Current Responsibility
Severity
Severity
Potential R. Actions Taken & R.
Class
Cause(s) / Process Process Recommended & Target
Potential Failure Mode Effect(s) of P. Completion P.
Mechanism(s) of Controls Controls N. Action(s) Completion N.
Requirement Failure Date
Failure Prevention Detection Date
s
Name, Part Manner in which part Consequences List every List List detection Design actions Name of Actions and
Number, or could fail: cracked, on other potential cause prevention activities to to reduce organization or actual
Class loosened, deformed, systems, parts, and/or failure activities to assure severity, individual and completion
leaking, oxidized, etc. or people: mechanism: assure process occurrence and target date
Function noise, unstable, incorrect process adequacy detection completion
inoperative, material, adequacy and prevent ratings. date
impaired, etc. improper and prevent or reduce Severity of 9 or
maintenance, or reduce occurrence. 10 requires
fatigue, wear, occurrence. special
0 0
etc. attention.
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
Severity of Effect: Occurrence Rating Detection: Stakeholder Effects of Failure Severity
No Effect 1. None 1. Very low <.01/1000 1. Almost Certain Consumer Owner Safety Problem ###
2. Very Minor 2. Low - 1/1000000 2. Very High (e.g., buyer) Major Owner Dissatisfaction 8
Annoyance 3. Minor 3. Low - 1/100000 3. High Moderate Owner Dissatisfaction 6
4. Very Low 4. Moderate - 1/10000 4. Moderate High Minor Owner Dissatisfaction 4
Loss or degradation 5. Low 5. Moderate - 1/2000 5. Moderate Customer Plant Safety Problem ###
of secondary function 6. Moderate 6. Moderate - 1/500 6. Low (Manufacturer) Possible Recall 9
Loss or degradation 7. High 7. High - 1/100 7. Very Low Line Stoppage 8
of primary function 8. Very High 8. High - 1/50 8. Remote Warranty Costs 7
Failure to meet 9. Hazardous with warnin 9. Very High 1/20 9. Very Remote AIAG PPAP 4th Scrap 7
safety/regulations 10. Hazardous w/o warnin10. Very High >1/10 10. Almost Impossible Regulatory Penalty 7
Moderate Rework (<25%) 5
Plant Dissatisfaction 4
Minor Rework (<10%) 3
Revision Code 0.0
Revision Co 6/26/2019 Process Flow Diagram
Page
Customer Customer Part Number 1 of 1
CustName 234
Supplier Supplier Part Number
Supplier 123
Part Name Dwg. Number Dwg. Rev Dwg. Date
123 123 0 6/26/2019
Core Team
CoreTeam
Characteristic
Out-
Op. No. Process Description No. going Control Method Description SC
10 1
10
11
12
13
14
15
16
17
18
19
20
Legend
Operation Inspection Op/Ins Transport Delay Storage Other
10 21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Use Drawing
Toolbar to Draw
Connectors
TRANSPORT 010
STORAGE 010
OTHER 010
OPERATION 010
INSPECTION 010
DELAY 010
Legend
Operation Inspection Op/Ins Transport Delay Storage Other
Prepared By Date Approved By
6/26/2019 0
Legend
Operation Inspection Op/Ins Transport Delay Storage Other
Prepared By Date Approved By
6/26/2019 0
Legend
Operation Inspection Op/Ins Transport Delay Storage Other
Prepared By Date Approved By
6/26/2019 0
APPEARANCE EVALUATION
Customer
Supplier Sourcing and Texture Information Pre-texture Representative
Evaluation Signature and Date
Correct and
Proceed
Correct and
Resubmit
Approved to
Texture
COLOR EVALUATION
Color
Color Tristimulus Data Master Master Material Material Hue Value Chroma Gloss Metallic Shipping Part
Suffix Number Date Type Source Brilliance Suffix Disposition
DL* Da* Db* DE* CMC Red Yel Grn Blu Light Dark Gray CleanHigh Low High Low
Comments
Comments
Customer Approval
Signature
Customer
Initials / Date
Date
Date
Date
Date
Change Description
ANY ITEMS NOT REQUIRED, PLEASE EXPLAIN: Reqd. Complete Date
3. Approvals
Engineering Manager: Quality Manager:
Production Manager: Plant Manager:
Comments
EFFECT OF CHANGE
INTERCHANGEABILITY AFFECTED TIME REQ'D TO INCORPORATE TOOLING OR FACILITY CHANGES REQD __ YES __ NO
ASSEMBLY __ YES __ NO CHANGE AFTER APPROVAL IF YES, COST EFFECT $
COMPONENTS __ YES __ NO
WILL INCORPORATION OF CHANGE PIECE COST AFFECTED __ YES __ NO
AFFECT SHIPPING SCHEDULE? SIGNATURE IFYES, COST EFFECT $
__ YES __ NO SUPPLIER REPRESENTATIVE
BLANKET APPROVAL GRANTEO FOR SUBSEQUENT SUPPLIER CHECKLIST ATTACHED? SAMPLE OF CHANGED COMPONENT
CHANGES WHICH ARE SAME AS DESCRIBED ABOVE REQUIRED
__ YES __ NO __ YES __ NO __ YES __ NO
REASON FOR REJECTION OR QUALlFYING CONDITIONS OF ACCEPTANCE
REVIEWED BY
SQA Date Purchasing Date
This approval is granted upon the understanding that it is advisory in nature and in no manner changes the Sellers original responsibilIty for insuring
that all characteristics, designated in the applIcable engineering specifications and/or inherent in the samples as originally tested and approved, are
maintained. Seller accepts full responsibility for the changes or types of changes lIsted above; and should such changes result in less satisfactory
__ YES __ NO
21 ISSUES (List DIM, APP, LAB, Process, tooling, capacity, Or start-up issues) ACTION PLANS (provide with date of completion)
Supplier
22 WHERE APPLICABLE, ARE INTERIM ISSUES ADDRESSED ON THE GP-12 PLAN? (eg rework, temporary operations)
II. The Part Meets All Engineering Performance Requirements. (e.g., Sub System
III. Comments:
IV. Part not meeting all engineering requirements specified above (section III).
Must be submitted on the GM1411 interim worksheet (the GM-E364 form does not apply).
Date:
(Signature)
(Code)
Supplier -> GM Engineer (DRE) -> Supplier -> SQE/Part Approval Activity
MATERIALS ENG.(SIGNATURE)
(PRINT NAME)
QUALITY ENG. (SIGNATURE)
SAMPLES CHARACTERISTICS
PER SAMPLE ACCEPTABLE PENDING
DIMENSIONAL
VISUAL
LABORATORY
PERFORMANCE
6. PACKAGING/SHIPPING QUANTITY
7. SIGN-OFF
Feasibility Considerations
Our product quality planning team has considered the following questions, not intended to be all-inclusive
in performing a feasibility evaluation. The drawings and/or specifications provided have been used as a
basis for analyzing the ability to meet all specified requirements. All "no" answers are supported with
attached comments identifying our concerns and/or proposed changes to enable us to meet the specified
requirements.
YES NO CONSIDERATION
Is product adequately defined (application requirements, etc.) to enable feas-
ibility evaluation?
Can Engineering Performance Specifications be met as written?
Can product be manufactured to tolerances specified on drawing?
Can product be manufactured with Cpk's that meet requirements?
Is there adequate capacity to product product?
Does the design allow the use of efficient material handling techniques?
Can the product be manufactured without incurring any unusual:
● Costs for capital equipment?
● Costs for Tooling?
● Alternative manufacturing methods?
Is statistical process control required on product?
Is statistical process control presently used on similar products?
Where statistical process control is used on similar products:
● Are the process in control and stable?
● Are Cpk's greater than 1.33?
Conclusion
Sign-off
Review/Modify/Create
FMEA Control Plan Work Instructions
Has Process or Procedure been changed? Yes No
If yes, date of audit:
Auditor:
8. Congratulate your team Close Date
Reported by
Name:
Department:
Implementation Date
Verification
Implementation Date
Implementation Date
1/1/2009