Professional Documents
Culture Documents
Company Name
Project
SIR Recipient (please send all sampling documents to following E-Mail address)
-
Initial Sample Inspection Subsequent Inspection
Level of Component Q-Qualification: "C" = Only SIR Short text stating reason for sampling:
In case of Level A or B please expand the sheet and select the enclosed CQP-items
Please select the enclosed items related to this SIR
19 BSH Sample Inspection Report (cover sheet) (Items nr. 11, 18, 19 and 22)
a Measuring Report / c Material Report/ e Appearance g Reliability Test 11 Supplier declaration (RoHS, REACH)
Process capability analysis
22 (Ppk;Cpk)
Dimension Check Material Test
b Functional Test d Haptics/ Acoustics/ Odors f Surface Check h Other: 18 Machine capability analysis (Cm;Cp)
We confirm, …
Supplier Part No. Delivery Note Date BSH Tool No.
1.
that the presented samples were manufactured
under standard conditions using standard Delivery Note No. Quantity Delivered (total) Number of Tool
operation resources,
to be completed by supplier
Limited Release,
###Quantity/ until Date #NAME?
###No Release
New Samples by
(Date)
#NAME?
#NAME? #NAME?
Name / Department Phone & Fax / E-Mail Date Signature
QM department Remark: Independent of the requested items the supplier has to document all applicable records, have to make them available on
Milestones / request and is responsible to ensure the part quality.
Synchronisation
points for: Prior to placement of order this document has to be agreed between BSH QM and Supplier.
The signed component qualification planning has to be send to the responsible BSH QM within 2 weeks after receipt
Planned without explicit request. This document is part of the release documents.
Level of Component Q-Qualification ### date
A B C Delivery
No. Item Comments
BSH Part Classification date
1 BSH specification X X X -
2 Feasibility study X X -
4 Production Layout X -
6 Control Plan X -
9 Design Release X -
12 FMEA Process E -
e Appearance -
f Surface check -
g Reliability test -
h Other: -
20 Reference samples -
23 -
24 -
25 -
Remark
Change Drawing
Test results Cavity of
Correct tool by
(measured):
supplier
Formnest
Teile-Gewicht:
Item-No.: New target
Nominal value Upper allowed Lower allowed Additional Information Actual value (Supplier) Actual value (Customer) value
Drawing deviation deviation
Field: 1 2 3 1 2 3
Remark
Change Drawing
Test results Cavity of
Correct tool by
(measured):
supplier
Formnest
Teile-Gewicht:
Remark
Change Drawing
Test results Cavity of
Correct tool by
(measured):
supplier
Formnest
Teile-Gewicht:
Item-No.: New target
Nominal value Upper allowed Lower allowed Additional Information Actual value (Supplier) Actual value (Customer) value
Drawing deviation deviation
Field: 1 2 3 1 2 3
Remark
Change Drawing
Test results Cavity of
Correct tool by
1 (measured):
supplier
Formnest
Teile-Gewicht:
Only to fill out for assembly parts (>1 part) complete by BSH
No. of
Part-No. Description Serial No. Drawing No. Drawing Status Material Colour Paint cavities MPP MPP
(Material) (Measure)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Comments
Remark
Department:
delivery specification
1935/2004 and/or FDA
EU RoHS Directive 2011/65/EU
carried out?
Self-colouring / Selbsteinfärbung SIR- or
REACH Candidate List RP-no.
Colour index Supplier of Raw Modification / Modifikation
Part Material Manufacture of Farbe (first release of
Change History name
Remarks
possibly concerning DIN/ISO Raw Material
Trade Name
(concerning
Material
Lieferant (Material)
EU RoHS
compliant
EU RoHS
compliant
EU REACH this raw material
manufacturer) only if deviating to B SVHC connected to
without with
PPN c. Layer Candidate list part name)
exemptions exemptions
version
Supplier
of list
10
B metal parts B
10
C rubber parts C
D oil/resin/paste/grease D
E others / mix E
Px Address Applic.
Abbrv.
FCGA
FCGB
FCGCa
FCGF
FCGI
FCGL
FCGM
FCGNa
FCGNb
FCGNb (2)
FCGS
FCGT
FCGWr
FCPB
FCPI
FCPN
FCPNa
FCPT
FCPV
FCPR
PCP/TE-TPB
PDC
FDCD
FDCE
FDCE
FDCI
FDCL
FDCM
FDCNb
FDCCh
FEDM
FEDNa
PED
PLC
FLCC
FLCCn
FLCD
FLCI
FLCL
FLCN
FLCNa
FLCP
FLCW
FRFC1
FRFC2
FRFCa
FRFE
FRFG
FRFI1
FRFI2
FRFP
FRFWr