Supplier Self Assessment (Short Form)

Supplier: White fields have to be completed !

Supplier No.:
Location of production

RED
Part Description: 0

Part Number(s)

YELLOW
Date: 0
Name:

x
x GREEN

Mark with "X"

Avg. Score: #DIV/0!

Evaluation key
1. No Compliance
Evaluation Comment
2. Major deviations
3. Minor deviations
4. Full compliance 1 2 3 4

Product Development

Are the customer specifications available?

Is the Control Plan, FMEA, Flow Chart available?

Is the process FMEA updated when corrective actions occur or

changes are made to the process?

Suppliers

Are only approved suppliers used?

Are suppliers performance monitored?

Are the stock levels of supplied materials matched to production

needs?

Is the stock delivery and storage according to their purpose, and is

FIFO practiced?

Is there an incoming receiving procedure?

Personnel / Qualification

Are the employees given responsibility and authority for the

monitoring of the product / process quality?

Are the employees given responsibility and authority for the

monitoring of production equipment and environment?

Are the employees suitable to perform the required tasks and is

their qualification maintained?

Is there visible evidence of employee motivation?

Production Materials / Equipment

Can the quality requirements be monitored effectively during serial

production with the implemented inspection, measuring and test
equipment?

F-QA-06-003 Issue 1 04/10 Page 1 of 4

 Evaluation key
1. No Compliance
Evaluation Comment
2. Major deviations
3. Minor deviations
4. Full compliance 1 2 3 4

Are the work and inspection stations appropriate to the needs?

Is an approval for production starts issued and are adjustments

details, as well as deviations recorded?

Are work instructions posted at the work center and do they follow
the control plan?

Is there a PM plan present and is it followed?

Is there a critical spare part listing and are these parts available?

Transport / Parts Handling / Storage / Packaging

Are the products / components appropriately stored and are the

transport means / packaging equipment tuned to the special
properties of the product /components

Are rejects, rework and adjustment parts, as well as internal

residues strictly separated and identified?

Is the material and parts flow secured against mix ups/ exchanges
by mistake and traceability guaranteed?

Are tools, equipment and inspection measuring and test equipment

stored correctly?

Are the gages used for measuring and monitoring set up in a

calibration system?

Fault analysis / Correction / Continual Improvement

Are the quality and process data recorded complete and ready to
be evaluated?

Are the quality and process data statistically analyzed and are
improvement programs derived from this?

Are the causes of product and process nonconformities analyzed

and the corrective actions checked for their effectiveness?

Are process and products regularly audited?

Are the target parameters available for the product and process
and is their compliance monitored?

General:

Is there a contingency plan available?

Is the supplier certified to a standard?

F-QA-06-003 Issue 1 04/10 Page 2 of 4

Audit Date: 30-Dec-99
Supplier : 0

No. Issue / Concern Champion Improvement / Correction Due Date Status

1
2
3
4
5
6
7
8
9
10
11
12
13
14

F-QA-06-003 Page 3 of 4
Issue 1
04/10
 Supplier Self Assessment (Short Form)

Supplier: ABC, Company White fields have to be completed !

Supplier No.: 33432
Location of production Greenville, SC

RED
Part Description: Widget 0

Part Number(s) 5564533

YELLOW
Date: 29-Mar-15 0
Name: John Smith
Title: QA Manager
X
X GREEN

Mark with "X"

Avg. Score: 3.7

Evaluation key
1. No Compliance
Evaluation Comment
2. Major deviations
3. Minor deviations
4. Full compliance 1 2 3 4

Product Development
Supplier Quality Manual not available at current revision level.
Are the customer specifications available? 3

Is the Control Plan, FMEA, Flow Chart available? 4

Is the process FMEA updated when corrective actions occur or

changes are made to the process? 4

F-QA-06-003 Page 4 of 4
Issue 1
04/10