Reference No.

--------------------------------

Date------------------

Proposed Trial No and Date

Trial Venue.
Trial Altitude
Project No. ---------------------------------Objective of trial-----------------------------------------------------------------------------------------------------------------------System/Subsystem details for QA clearanceData Link
(Electrical/Electronics/Instrumentation)
Following components/parts/sub system/system have been functionally and visually checked in
presence of rep QA. The details of test and system fitness certificate are as mentioned bellow:
1) List of Trial Stores:
S.
No.

System/sub
system
Description

Qty

1.

Ethernet Device
Switch

01

DOM

Specification
/Drawing
No./Make
Attached

Readiness
Status(Lab Test
Report to be
enclosed)
Ready

Grade of
Item(A/I/*C)

Rep QA
Sign

Remark

2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

A=Airborne; I=Industry; *C=Commercials,

*Please add justification
2) List of harnesses/wire connectors:
Color/Code/Name of wire
Length used
a)
b)
c)
d)
e)
f)
.

DOM= date of Manufacture

Purpose

other relevant information

3) Calibration reports (to be enclosed): ..

4) ATP compliance report (Copy enclosed): .

5) Grade of bought out/COTS items:

MIL Grade
*Please justify and concession for deviation

Industrial

*Commercial

6) Simulated ground/ dynamic test conducted: (Enclose the schematic diagram/ layout according to
which ground test has been done)
(6.1) Date of test:
(6.2) Performance of test: .
(6.3) Defects observed & remedial action (if any):
(6.4) Report (enclosed):
7) Operational life of Subsystem/Part System:
Item Name

Total life

7.1
7.2
7.3
7.4
7.5

8) Probable weakness/defect during purposed trial:

Consumed Life

Residual

9) Last modification done & Type of modification:

10) Safety clearance obtained for the trial:

yes/No

11) Integration Process sheet /report:

* Strikeout whichever is not applicable

12) Fitness certificate for this trial:

The Parts/Subsystem/System has been checked & tested (support document enclosed vide
Doc. No.

) and found fit found fit for proposed dispatch / pre integration /

integration / trial as mentioned in the SOP vide document No. ADRDE/QMS/ ..

Dated.
Inspection by/GO

Group Director / System

QA / Observation:

Cleared / Not cleared / Concession

Head/R&QA