Supplier Self Assessment (SSA)

For procurement enquiry : Date:

Sourcing No.: Part-No.: Part Name:

The return of the supplier self assessment is an obligation (and where appropriate with attachments). The details are exclusively
related to the actual manufacturing site! Please return the completed form immediately! - (please insert additional lines if necessary)

1. General Data Supplier

Company name: Responsible: Sales Research&Development Quality
Name:

Tel. No.:
Mobile Phone:
If relevant please provide former name of Email:
the company:
Languages: German German German
English English English
Spanish Spanish Spanish
French French French
Internet-Hompage:
Address of Manufacturing site: Address of Development Centre:

Supplier Nr. (internal)

D-U-N-S No.: D-U-N-S No.:
Turnover p.A (€): Number of Employees: Number of Employees Development: Number of Employees Quality:

1.1 General Information for the actual Supplier Programme :

Series deliveries of quoted products/product groups from the manufacturing site:
Parts/Products Customers/Plant(s), Vehicle Types Annual Volume Since

1.2 Assessment of Quality

(Cert. DIN/ISO 9000/EN 29000 - Volume/VDA Bd.6/QS 9000/IATF 16949
(Please send the cover page of the last audit)
Parts/Product Groups Company/Auditor Cert. To % Grade Date

1.3 External Suppliers

Is it planned that important features e.g. functional and quality relevant components for the currently requested project Yes No
will be purchased from external suppliers. Will external service suppliers be used for the actual quoted project (e.g.
machining, assembly, painting).
Parts/Product Groups Supplier/Company Cert. To % Grade Date

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Sourcing No.: Part-No.: Part Name:

1.4 Tool Maker Yes No

Is there a tool making facility at the supplier site?
Name and address of the tool maker: Contact/Tel. No.:

2. Development
2.1 Joint Venture Partner / Know-how cooperation
Company/Contact: JV-Share (in %) Cooperation Partners Financial Contribution of Partners

Tel. No.: Fax No.:

Which components involve a JV or know-how cooperation? Partner:

2.2 Core Competencies

Core Competencies:

2.3 Research and Development Departments Yes No

Is the supplier capable to handle all aspects of research and development:
If not, which development work requires to be done elsewhere:
Operation Partner/Organisation License/Joint Venture

2.4 Project Management, Methods of Product Development Yes No

Does the supplier have the project management/development at the OEM site? (e.g. local engineering office)
If yes, contact person and contact details:

Which Development- and Quality Methods are used by the supplier?

a) QFD Methods:
b) FMEA (Design FMEA, Process FMEA):
c) DOE Methods:
d) Others:

2.5 CAD Engineering Systems? Yes No

Does the supplier have CAD Systems?
If yes, what systems are they:
1.
2.
Is there a CAD-Data link?
If yes, what sort of link is in use?
Does the supplier use simulation methods?
If yes, what are the systems?
1.
2.
3.

2.6 Innovation Yes No

Does the supplier hold patents?
If yes, for which products or processes: locally Intern.

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Sourcing No.: Part-No.: Part Name:

2.7 Laboratory Equipment: Yes No

Which equipment is available at the suppliers site? available at site ?

Which laboratory equipment is used externally? Partner / Organisation

2.8 Test Equipment Yes No

Which functional test rigs does the supplier maintain at the site? available at site?

Which test rigs are used externally? Partner / Organisation

Which endurance test rigs are maintained at the site? available at site?

Which endurance test rigs are used externally? Partner / Organisation

Which measurement- and analysis equipment does the supplier maintain? available at site?

Which measurement-and analysis equipment is used externally? Partner / Organisation

2.9 Test Facility / Prototyping Yes No

Does the supplier maintain a test facility or prototyping on site?
Which prototyping facilities are used internally?

Which prototyping facilties are used externally? Partner / Organisation

3. Other Information
3.1 Export

Which components are exported and for which customers? How much is the share for the net value of such products?
Components: Customers: Product Net Value:

3.2 Comments / Attachments

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