Initial Visit Quality Surveillance Report

Form SQ-221-IV
Request 18901

QSR Number: 25768-230-YQA-JV01-10001 QSR Revision Number: 000

Project Name: STONEWALL

I. General
Assignment Number 25768-230-YZA-JV01-10001 Project No. 25768
PO Number 25768-230-POA-JV01-00001 Rev No. 0
Material on Order General Service Control Valves
Surveillance Level 1 2 3 4 S/O No.      
Prime Supplier: (visited) Sub-Supplier: N/A
Company Name: Flowserve India Control Private Company Name:
     
Limited
Street Address: Plot # 4, 1A, Road No. 8, Street Address:      
City: Bangalore City      
State/Province: Karnataka State/Province      
Postal Code: 560066 Postal Code:      
Country: India Country:      

II. Visit/Production Status

Visit Date(s) (Day-Month-      
Year) List specific dates in shop.
Identify Specific Quality Surveillance Activities Performed This Report Period: (check all that apply)
Project-Directed Status Report Witness/Hold Point In-Process Quality Program
Verification
Final Report - Assignment Complete
Prime Supplier’s Representative was in attendance for this scheduled visitation: Yes No
Describe Next Surveillance Planned Activity:
Tentative Next Visit Date:       or TBD
Next Visit Surveillance Points:
     
(be specific: In Process Fab., Weld, Hydro, Final, etc.)

Quality Surveillance Plan / Material Acceptance Plan – Material Requisition/Specification Quality Surveillance
Activity Reporting
Within the table below identify the Quality Surveillance Plan or Material Acceptance Plan activity as required by the Quality Surveillance
Plan/Material Acceptance Plan or as required by the Material Requisition, Specification and/or Assignment Transmittal Special Instruction, as
applicable in the Activity Description area(s). Each time a point is performed and/or verified during a surveillance visit, record the date performed.

Material Acceptance Plan No.: (When Issued)       Rev. No.      
Point
Activity Description Performance Date(s) (Day-Alpha Month-Year)
No.

Form SQ-221-IV Page 1 of 11

SQ-221-IV Rev. 008 Effective Date – February 1, 2013
 Initial Visit Quality Surveillance Report
Form SQ-221-IV
Engineering in Process - Basic Percentage Completed to       %
Date
Procurement in Process - Basic Percentage Completed to       %
Date
Mfg. Status (On hold, in process, etc.)       Basic Percentage Completed to Date       %
PO/MR Ship Completion Date New Estimated Ship Completion Date
           
(Day-Month-Full Year) (Day-Month-Full Year)
Supplier’s Overall Current Shop Workload Including all other customer’s Purchase Orders       %
percent of Capacity All Bechtel Orders or Sub Orders       %

III. Supplier Contacts

Primary Supplier Sub-Supplier
Name
Title/Position
Telephone
Facsimile
Email

IV. Material released for Shipment with this Report No Yes SQ-231 attached
If yes, embed the completed SQ-231 Material/Equipment Release Form here or send the SQ-231 Form as a separate attachment
when submitting this report.

Form SQ-221-IV Page 2 of 11

SQ-221-IV Rev. 008 Effective Date – February 1, 2013
V. Supplier Nonconformances/Issues Action Items and Supplier Performance Data Information
Within the table below, identify all nonconformances, issues and action items reported in Section VI “Summary of Surveillance Activities Performed – Surveillance Narrative Summation.” Ensure to
include nonconformances, issues and action items that were found and corrected within this reporting period. Carry all nonconformances, issues and action items (open or closed) from report to report.
Project will identify when closed nonconformances, issues or action items are to be removed from the report.
Report Number-Item Number – Each issue or action item should be entered in its own row numbered with (Report No) – (sequential Item No) e.g. the first three issues or action items for report number
one are 1-1, 1-2, 1-3…Report 2 would be 2-1, 2-2, 2-3, etc.
Anomaly Codes - Supplier Performance Data (SPD) — Within the table below enter an Anomaly Code for each Item that is a nonconformance or reportable supplier performance issue.
“Anomaly Codes” are to match nonconformances and issues identified in the Bechtel SPD Chart and must be detailed in this report Section VI “Surveillance Activities Performed.”
Ensure to include nonconformances and issues that were found and corrected within this report period.
If there are no nonconformance issues found during the visit enter a row in the table below for the visit with Anomaly Code M11.

Report
Responsible CAR/QDR
No. Primary Date Anomaly
Condition Description for Correction or Closure Justification
– Component Resolved Code
or Action SDDR
Item No.

1-1

Action Items/Punchlist of Open Items was left with:

VI. Summary of Surveillance Activities Performed
Exception Activity
Initial Visit Activities
Yes No N/A

A. Attend to administrative duties such as introductions, alternative contacts,

and primary functions/duties.

B. Determine Supplier imposed safety requirements for office and manufacturing

areas and discuss the Bechtel safety requirements of the SQR.

C. Discuss Bechtel’s Supplier Quality and Expediting Application Suite (SQEAS),

and how anomalies will be recorded against the Supplier, and the Supplier is
expected to be proactive to prevent recurrence. Mention that Supplier
Performance Data is utilized as a supplier evaluation tool.

D. Correlated the procurement documents held by the supplier and the Supplier
Quality Representative.

E. Reviewed and discussed with the supplier the Purchase Order requirements
listed below.

E1) The technical, quality and the applicable requirements of the Purchase Order,
Specifications and Governing Codes and Standards.

E2) The requirements for Project Engineering review of supplier documents.

E3) The requirements for quality surveillance at principal sub- suppliers’ plants.

E4) The requirements for qualification of welders, non-destructive examination

personnel, and inspection, examination and testing personnel.

E5) The requirements for witness and hold points including release for shipment.

E6) The requirements for complete and accurate Quality Verification

Documentation prior to release for shipment.

E7) The requirements for obtaining written authorization of deviations such as

Supplier Deviation Disposition Request or similar form.

E8) The requirement for the supplier to establish “Counterfeit, Fraud, Suspect
Items” procedure or program when required by the PO.
Project and/or Supplier Documents used for this Surveillance Table
For the “current” quality surveillance visit, identify the Project and/or Supplier Document(s) (Specifications, Data Sheets, Procedures, etc.) used in the
performance of quality surveillance activities. Identify the revision; general description and the “Review Code Status Number” as it applies to Project-
reviewed documents and N/A (not applicable) for Customer/Supplier documents that do not require submittal.
Review Code
Document No. Rev. Description Status
(1, 2, 3, 4, N/A, etc.)

Surveillance Narrative Summation

Provide a detailed summary of quality surveillance activities performed for this report’s visitation in the applicable sections below to correlate with
“Initial Visit Activities” table above. Ensure that item numbers, and/or part numbers are identified and include a general description of the item.
Describe the activity performed and the essential attributes that apply to the activity. When inspection and/or test equipment is utilized, record the
calibration status. Where certified personnel are required to be utilized, identify the person and status of the certification. Identify the required
“Acceptance Criteria” and the results as “Satisfactory”, “Meets the Acceptance Criteria”, “Unsatisfactory”, and/or “Rejected.” Ensure that all reported
nonconformances and issues are reported back into Section V table,” Nonconformances/Issues and SPD” and verify that the correct SPD code is
recorded.
VI-A Administrative Introductions

On this assignment package was preplanned in accordance with the assignment transmittal and procedural
instructions. As part of this preplanning activity, it was verified that the assignment contained the required PO,
Specifications, and Quality Surveillance Plan/Material Acceptance Plan. These documents were reviewed for content
and understanding.
(indicate either one or the other, it is not both - Quality Surveillance Plan or Material Acceptance Plan)

On writer entered the Supplier’s facility to conduct the initial visit activity. Met with the following Supplier
personnel:

Name Title

As part of the introduction process, business contact information was exchanged. The contact information
for writer’s immediate supervisor and the Project PSQS/PSQR was provided as an alternate, where situations
may occur if writer cannot be reached in a reasonable time. The Supplier was instructed to contact the SQR
to arrange for coverage of surveillance activities in accordance with the assignment Quality Surveillance
Plan/Material Acceptance Plan.
(indicate either one or the other, it is not both - Quality Surveillance Plan or Material Acceptance Plan)

The Supplier was also provided the Project Surveillance Notification Letter, which is to be sent to the Project e-mail
address for notification of events. The Supplier has agreed to make both contacts to this SQR and Project. The
Supplier was instructed that final acceptance of material/equipment is made at the jobsite.

The supplier takes No Exception/takes the following exceptions.

(If the assignment transmittal does not require this form, this paragraph is to be deleted in its entirety.)

VI-B Safety

Discussed with the Supplier their requirement that this SQR must adhere to in regards to environmental, safety and
health while in the Supplier office and manufacturing areas and that of sub suppliers that this SQR may be required to
visit to perform surveillance activities. Also discussed with the Supplier the SQR’s requirement that this SQR must
follow as required by Buyer’s procedures. The Supplier was informed that it is the Supplier’s responsibility to ensure
visitor safety and that this SQR will not enter areas of the shop or perform surveillance activities that will put this SQR in
an “at risk” situation. If the SQR determines an “at risk” situation, the Supplier will be informed to correct the
unsatisfactory safety condition before surveillance activities resume.

The Supplier’s minimum requirement is to wear . Of these two requirements discussed (Supplier’s and
Buyer’s requirements) the SQR will follow the more stringent of the two, being the requirement.

The Supplier takes No Exception/takes the following Exceptions:

(If the Supplier takes any exception, note here and be specific.)

VI-C Supplier Quality and Expediting Application Suite – Supplier Performance Data

Discussed with the Supplier the Supplier Quality and Expediting Application Suite and the identification of anomalies
found during visits. It was explained that issues, anomalies, and nonconformances as found by this SQR will be
translated into anomaly codes and entered into the Surveillance Report. Project will then enter these codes into the
SQEAS database. Supplier Performance Data is used by projects to trend Supplier performance, and this may affect
the Supplier’s ability to quote and secure new work. Negative trends determined during the assignment may be used
for basis of back charge of SQR’s services for implementing the Supplier’s QA/QC program, where the Supplier fails to
satisfactorily implement. No Exception
(If the Supplier objects, identify here and in Table V. Note: There is no exception, regardless if the Supplier objects. SPD is a Buyers application tool.
The only time SPD is not applicable is when the Project indicates in the SQ-211 Assignment Transmittal that SPD is not to be utilized.)

VI-D Correlation of Procurement Documents

Writer correlated all documents and revisions in the received assignment package with those held by the Supplier.
During this review the Supplier was explained the order of precedence of these documents as:

 Customer Purchase Order

 Customer Design Drawings, Data Sheets and Design Documents
 Supplier Drawings, Data Sheets and Procedures reviewed by the Customer
 Supplier drawings, data sheets, and procedures that do not require review by the Customer

This review determined that all documents are in agreement with No Exceptions (with the Exception of):
(Identify only those documents and revisions where there are exceptions and identify in Section V, Nonconformance’s/Issues and SPD Table.)
VI-E1 Technical, Quality and Codes and Standards Reviews

Reviewed with the Supplier the key technical, quality requirements of the governing Codes and Standards and the
procurement documents and inclusive Specifications. Upon finalization of this review, it was determined that the
Supplier has

The Supplier takes No Exceptions (the following Exceptions):

(If exceptions identify PO/Specification/Data Sheet/Code/Standard…number, paragraph, brief requirement, and Supplier exception. Then make a
statement that the Supplier has been instructed to follow through directly with Project for resolution. Note: If clarification is needed, identify as such
and this needs to be treated as an issue and again reported in Section V, Nonconformance’s/Issues and SPD Table.)

VI-E2 Data Submittal for Project Review

Discussed with the Supplier the engineering and quality verification document submittals required by the
PO/Specification that the Supplier must submit to Project for review and status. Discussed the required time frame for
submittal. Explained to the Supplier the document review codes. Explained to the Supplier any items manufactured to
Code 2 returned documents must have all comments incorporated into the material/equipment in order to be
acceptable.

It was also explained to the Supplier that any submitted document returned as Code 1 and has an attribute that
deviates from a contract PO/Specification/Code/Standard requirement that the Code 1 review is not the basis to except
the deviation. These types of deviations are required to be addressed separately to Project Engineering for written
approval as required by the PO documents.

The Project coded document needs to be provided to the SQR to execute surveillance activities.

The Supplier takes No Exceptions (the following Exceptions):

(If exceptions – identify specifically which documents there are exceptions or the time frame submittal exception and again report in Section V,
Nonconformances/Issues and SPD Table.)

The Supplier has made the following (No) submittals to date and returned Code status is identified where applicable:
VI-E3 Supplier and Subsuppliers/Contractors of Services

Discussed with the Supplier their intent to subcontract all or portions of the material/equipment. Discussed the possible
surveillance that may be performed at a particular Subsupplier/Contractor. The surveillance to be performed includes
the applicable portions as required by the Quality Surveillance Plan/Material Acceptance Plan. Project will determine if a
Subsupplier/Contractor will have surveillance overview. Addressed the PO contract right of access clause.
(indicate either one or the other, it is not both - Quality Surveillance Plan or Material Acceptance Plan)

The Supplier takes No Exception (the following Exceptions:

(If exceptions – identify specifically here and again in Section V, Nonconformance’s/Issues and SPD Table.)

The Supplier is subcontracting the following material/equipment/custom fabrication/service:

(If the Supplier has not yet determined whom the subsupplier or subcontractor will be, still identify the equipment or service to be subcontracted.)

Equipment – Services Description Sub-Supplier/Contractor Name Location (Complete Facility Address)

VI-E4 Qualifications of Personnel

Reviewed with the Supplier the Code/Standard requirements for the qualifications of welders, NDE, inspection,
examination and test personnel.

The Supplier takes No Exceptions (the following Exceptions):

(Identify the specific exceptions and again identify in Section V, Nonconformance’s/Issues and SPD Table.)

Writer requested and reviewed the following sample of special process personnel certifications/qualifications:
If this activity is not pertinent to perform at this time, this paragraph is to be deleted and the following paragraph would apply.)

Writer will later review certifications/qualifications of special process, examination and test personnel once they are
assigned to this order.

VI-E5 Quality Surveillance Plan or Material Acceptance Plan and Notification

Reviewed with the Supplier the PO contract Quality Surveillance Plan/Material Acceptance Plan progressive, witness
point, and hold point requirements. Reviewed the notification time line requirement for witness and hold points as
defined by the PO contract documents. Notification will be made to this SQR and also to Project. Time line indicated by
the PO/contract as working days for North American facilities and working days for off shore facilities.
(indicate either one or the other, it is not both - Quality Surveillance Plan or Material Acceptance Plan)

The supplier was advised that bypassing a hold or witness point will be treated as a nonconformance, a Corrective
Action Report/Quality Deficiency Report will be issued and the operation will have to be repeated unless otherwise
directed by the project. It was also explained that hold points could only be waived by Project concurrence.
(indicate either one or the other, it is not both - Corrective Action Report or Quality Deficiency Report)

The Supplier takes No Exceptions (the following Exceptions):

(If the supplier takes any exceptions these are to be identified here and listed as an issue in Section V, Nonconformance/Issues and SPD Table.)
VI-E6 Quality Verification Documentation

Discussed with the Supplier the requirement for the submittal of Quality Verification Documentation in accordance with
the PO/Specification. It was explained that the documentation is to be submitted to the SQR prior to release for
shipment so that it can be reviewed. Before submittal, it is the responsibility of the Supplier to pre-review and ensure
that the documentation is complete, accurate, legible, and traceable. Any documentation presented that does not meet
these criteria will be rejected. This SQR would also request review of inspection and test data, certifications of
qualifications of special process personnel, material test reports, etc., during the course of progressive, witness point,
and hold point surveillance activities. The Supplier will be informed with any issues with those records at time of these
in process and final reviews.

The Supplier takes No Exceptions (the following Exceptions):

(If the supplier takes exceptions, be specific and also document in Section V, Nonconformance/Issues and SPD Table.)

VI-E7 Deviation Submittal and Approval

Discussed with the Supplier the requirement to have all deviations from PO/Specification/Code/Standard contract
requirements submitted to Project Engineering for review and disposition. It was stated that it is the responsibility of the
Supplier and not this SQR to notify the Project. Submittal is to be made in writing by the contract required SDDR form
or other written format if agreed by Project Engineering. Approved SDDR and/or other written approval are to be
presented to this SQR and the approved SDDR’s will require SQR counter signature and placement within the Quality
Verification Documentation package.

It was again explained that a Code 1 review status received from Project on a drawing or procedure does not constitute
a deviation approval.

The Supplier takes No Exceptions (the following Exceptions):

(If exceptions are taken, specify. The Supplier may take an exception, but it is a mute point, since it is a contract requirement. Also identify in
Section V, Nonconformance’s/Issues and SPD Table)

VI-E8 Counterfeit, Fraud, Suspect Items (CFSI)

Reviewed the Purchase Order and determined that the supplier is (or) is not required to establish a specific procedure
or program to address measures taken to prevent introduction of counterfeit, fraud or suspect items into the supply and
manufacturing proccess.

Where this is an established requirement the supplier procedure/program is:

Where this is not an established requirement, the supplier was asked if there is an established procedure or program
addressing CFSI. The supplier response was….

The Supplier takes No Exceptions (the following Exceptions):

(If the supplier takes exceptions, be specific and also document in Section V, Nonconformance/Issues and SPD Table.)
VII. Prepared/Review Section
This surveillance was performed in accordance with the requirements of Purchase Order, Specifications, Quality Surveillance Plan/Material Acceptance Plan and/or
Project Direction

Prepared by SQR       Date      

(Day-Alpha Month-Full Year)
Reviewed by Date
           
PSQS/PSQR (Day-Alpha Month-Full Year)
Hours
Charge Original
Budget Hours Hours Used to
Number: 25768-120 Hours 100       0
Revised Date*
Budgeted
Within the table below enter the hours worked for this report only. Separate line for each person each day.
* Hours Used to Date is auto calculated form the total at the bottom of the table below.
PN: For this table to work properly make sure that:
1. The Document is protected (menu:: Tools; Protect Document)
2. Always press the Tab or Enter key after you input each value to force calculation of totals.
3. Do not delete or insert new rows. Enter Dates: (Day-Alpha Month-Full Year) ex: 30-Jun-2010
Pre- Visit &
Name Date Travel Total
Plan Report
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Totals for this Report 0 0 0 0