Date:

Supplier Quality Self Audit Questionnaire Form

DUNS #

Supplier Name

Complete Mailing Address

Complete Shipping Address

(if different then mailing address)
Main Phone Number
Main Fax Number
24-Hour Emergency Phone
Numbers

Commodity to supply ACEMCO

ACEMCO Purchasing Contact Ken Wilson
Company Web Page Address

Name/Title e-mail Address Phone Number Fax Number Cell Number

Main Contact Person/Title

President
Vice President Finance
Plant Manager/Operations
Manager
Account Representative

VP Engineering
Quality Manager
Designated NCMR/CAR Contact
& Title
Backup NCMR/CAR Contact
& Title

If not Certified
to
TS 16949,
Quality Certifications and/or
Next Re- ISO 9001,
Customer Awards Date of Original Last Re-Certification
Certification ISO 17025 or
(e.g.:Q1, Pentastar, GM Certification Date
Date ISO 14001, list
Excellence, etc.)
projected
certification
date

Return completed form to:

Type of Union Expiration Dates ACEMCO Incorporated
N/A 7297 Enterprise Drive
Spring Lake, MI 49456

Form #SSA-01 A
file:///conversion/tmp/scratch/515083399.xls
Revised 6/25/07
 Attention: Ken Wilson

Form #SSA-01 A
file:///conversion/tmp/scratch/515083399.xls
Revised 6/25/07
 SUPPLIER QUALITY SELF AUDIT & QUESTIONNAIRE FORM

The purpose of this questionnaire is to provide a general understanding of the nature of the supplier's quality organization and
approach to quality. The response to these questions should be provided by the facility that will be supplying the product. Please
answer each question by typing, or printing in ink, an "X" in the appropriate box, or by filling in the blanks. Return the completed
questionnaire to our Purchasing Department. The questionnaire will be distributed to the appropriate personnel for evaluation and
possible follow-up audit. All "No's" must have a declaration statement in the additional comments section. See Example.

Plant Information (For this location):

1. Basic Products:

Timeframe
Customer PPM (month/qtr/annual) Tier1/Tier2/NBH
2. Major Customers, Rolling 12
PPM's, Tier-1/Tier-2, Rolling 12
New Business Hold: Rolling 12
Rolling 12
Rolling 12
Rolling 12
Rolling 12

Internal PPM: Rolling 12

3. Major material suppliers:

4. Do you utilize just in time (JIT) delivery? YES NO

5. Do you utilize First In, First Out (FIFO)? YES NO

6. Do you have product liability insurance? YES NO If so, what amount?

7. Total facilities area: square feet. Shifts:

(# x hrs x days)
8. What percent of capacity is utilized? %

9. Year Established: Equity change: YES NO Year:

10. Personnel: Total Employees Mfg. Hourly Total Salaried

Quality Hourly Quality Salaried Engineering

11. Union Affiliation: Date Contract Expires:

12. List laboratory / test facilities:

13. Describe prototype capabilities:

14. Describe Design capabilities:

Do you use CAD / CAM? YES NO

15. Organizational structure: (Attach a copy of both the Plant & Quality Organization charts)

16. Please attach copy of all Third Party Registrations.

17. What are your capabilities / capacities for the projected product?

18. What specific contingency plans are in place in the event of an interruption in processing?

YES NO
Form #SSA-01 B
Revised 6/25/07
 SUPPLIER QUALITY SELF AUDIT & QUESTIONNAIRE FORM
A. General Systems YES NO YES NO
1. Is the quality department a separate / distinct part of your organization?
2. Are there written procedures defining the quality - related functions?
3. Does the Quality Department have the authority to control non-conforming material?
4. Do you have a documented quality related training program?
5. Do you have a system for customer complaints and rejections?
6. Do you have a specific department or organization responsible for advanced quality planning
on new products?
7. Do you have a procedure for approval of new & rebuilt machinery / equipment?
a. Does this procedure call for a minimum of 10-sigma (± 5) capability?
8. Do you have a quality cost reporting system?
9. Do you regularly perform internal quality system audits to assure compliance to your existing
quality procedures?
10. Does your procedure require customer notification of continued registration?
11. Does your procedure require that "loss of third party registration" be communicated to your
customer?
12. What are the supplier's current methods of delivery / shipping?
Truck

13. What experience does the supplier have in international sales?

Canada and Mexico

14. What experience does the supplier have in import / export activities?
No Importing or Exporting beyond Mexico and Canada

B. Statistical Process Control

1. Do you have an ongoing program to train employees in SPC?
2. Do you have documented SPC for significant product characteristics (<CI>, <SC>) &
process parameters?
3. Is manufacturing responsible for SPC?
4. Does your SPC program require (min) 1.33 Cpk & 1.67 Ppk?
5. In instances where process capability has not yet been demonstrated, do you require a
documented plan to improve the process?
6. Do you use statistical techniques such as Design of Experiments, Pareto Analysis, Regression
and correlation analysis, etc?

C. Drawing and Specification Control

1. Does the quality function review related drawings and specifications for new products
before acceptance?
2. Are controls in place to assure the latest drawings, change notices and specifications are
in use by manufacturing and quality personnel at the point of production and inspection?
3. Are there document and data control procedures?
4. Is there a record retention procedure? (Life of Product & Service + 1 year).
5. Have you performed a team feasibility study with regard to MS-1 thru MS-5 tubing specifications?

D. Measuring and Test Equipment Control

1. Is all measuring and test equipment uniquely identified?
2. Do you have a calibration and control procedure in place?
3. Are calibration standards traceable to the National Institute of Standards and Technologies
(NIST) or appropriate international standards?
4. Are GR&R's performed on all types of measuring devices?

E. Purchased Material and Service Control

1. Do you have a Supplier Quality Manual?
2. Is a list of approved suppliers maintained?
3. Are suppler quality audits/surveys conducted?
a. Do you conduct Supplier Self-Assessment Audits?
b. Do you conduct on-site audits?

Form #SSA-01 B
Revised 6/25/07
 SUPPLIER QUALITY SELF AUDIT & QUESTIONNAIRE FORM
YES NO
4. Are suppliers required to use SPC and are records/data available?
5. Are in-house or external heat treat sources approved to specific or specified heat treat
specifications (e.g.: AIAG Heat Treat Assessment, Ford WHTX Evaluation) ?
6. Do you require supplier material certifications & routinely verify same?
7. Are inspected materials uniquely identified from those awaiting inspection?
8. Do you have controls to prevent movement of rejected incoming material to storage
or point of use?
9. Do you have AIAG APPROVED bar coding capabilities?
10. Do you have product traceability from incoming through shipped product?
11. Do you have documented procedures for contract review?
12. Have you logged into MDSystem.com to input IMDS information?

F. Non-Conforming Material Control

1. Are controls in effect to prevent movement of non-conforming or suspect material back into the
normal production flow?
2. Is non-conforming product analyzed to determine cause and effect?
3. Do you take corrective action to prevent recurrence of non-conformity?
4. Is there a procedure for timely disposition for non-conforming material?
5. Do you have segregated hold areas for non-conforming material?
6. Is reworked or sorted material resubmitted for inspection?

G. In-Process Control / Inspection and Testing / Inspection Test Status

1. Are you capable of producing products to ACEMCO's material specifications.
or customer specific material standards?
2. Are you able to comply with specific requirements to the ACEMCO Supplier Manual?
3. Do you have methods of control of material chemistry
A1 content targets, etc), microstructure and mechanical requirements? <Special
attention must be given to the supplier's raw material supply / source for controls.>
4. Do you have process controls for welding (ERW) and/or heat treating (annealing,
normalizing) of all component parts including non-destructive testing, physical testing, and
certification methods?
5. Do you have methods of control of all component surface conditions / finish, corrosion protection,
packaging, and shipping.
6. Do you have a "bullet proof" material lot traceability and control, which may include
a lot "buy off" prior to shipment from the point of manufacture?
7. Does your company have documented procedures for identifying and planning the production,
installation and servicing processes which directly affect quality, and do the procedures ensure
these processes are carried out under controlled conditions?
8. Does your company have documented procedures to ensure compliance with all applicable
government, safety and environmental regulations, including those concerning handling, recycling,
eliminating or disposing of hazardous materials?
9. Does your company have documented procedures to ensure compliance with all customer
requirements for designation, documentation and control of Special Characteristics?
10. Can you produce documentation showing compliance with requirements, if requested?
11. Have you identified key process equipment and provided appropriate resources for machine/
equipment maintenance through a documented, effective, planned total preventative maintenance
system?
12. Does your company have documented process monitoring and operator instructions for all
employees having responsibilities for operation of processes?
13. Are these instructions easily accessible at the work stations?
14. Does your company conduct preliminary process capability studies for each supplier or customer
designated Special Characteristic for new processes?
15. If no requirements have been specified, what values do you maintain for process performance?

Preliminary result (less than 30 production days): PpK = Min.

Ongoing process performance for stable & normally distributed data: CpK = Min.

Ongoing process performance for chronically unstable processes with output PpK = Min.
meeting specifications and a predictable pattern:
15a. Is there documentation available for inspection which shows that you are in compliance with
these values?
16. Does your company have documentation available for set-up personnel and are job set-ups
verified as producing parts that meet all requirements?

Form #SSA-01 B
Revised 6/25/07
 SUPPLIER QUALITY SELF AUDIT & QUESTIONNAIRE FORM
YES NO
17. Does your company have documented procedures which will ensure that any changes in part
number, engineering change level, manufacturing location, material source(s) or production
environment receive approval from the customer prior to implementation?
18. Does your company maintain records of the effective dates for process changes?
21. Does your company have documented procedures for inspections and testing activities
needed to verify that specified requirements for the products are met?
Does this include:
Receiving Inspection and Testing
In-Process Inspection and Testing
Final Inspection and Testing
22. Are the required inspections, tests and the records established, detailed in the Control Plan
or other documented procedures?
23. Does your company have documented procedures for the release of incoming product at
Receiving Inspection for urgent production purposes?
24. Do these procedures require positive identification and recording of the released product in
order to permit immediate recall and replacement in the event of nonconformity to specified
requirements?
25. Do the procedures for In-Process Inspection include the holding of product until the required
inspections and tests have been completed or necessary reports have been received and
verified, except when product is released under positive recall procedures?
26. Does your company have documented procedures for performing layout inspection and
functional verification for all products at a frequency specified by the customer?
27. Does your company maintain inspection and test records which provide evidence that the
product has been inspected and/or tested and which clearly indicate whether the product has
passed or failed according to defined acceptance criteria?
28. Does your company have documented procedures for the identification of product to indicate
the conformance or nonconformance of the product with regard to inspections and tests
performed?
29. Do these procedures ensure that the identification of inspection and test status is as
defined in the applicable Control Plan and that it is maintained throughout production to
guarantee that only production that has passed the required inspections and tests, or
released under authorized concessions, is dispatched, used or installed?

H. Finished Product Verification

1. Does finished product receive a final inspection by the Quality Department?
2. Are inspection/test procedures or instruction sheets used?
3. Do you perform PPAP submissions for all customers per AIAG current standards?
4. Does your PPAP process require customer notification and concurrence (designated
using facility) prior to shipping product?
5. Does your PPAP process include provisions for yearly customer PPAP submission
(including sub-components)?

I. Customer Deviation / Concession

1. Do you have a deviation/concession procedure?
2. Does it include customer approval authority for the deviation/concession?
3. Do you have a procedure that requires customer notification when submitting a
Supplier Request for Engineering Approval (SREA) directly to an OEM?
4. Does the procedure require (using) customer concurrence after an OEM approves an
SREA, on product supplied directly to (using) customer?

J. Corrective and Preventive Action

1. Does your company have documented procedures for corrective and preventive action?
2. Do your corrective action procedures ensure:
a.) The effective handling of customer complaints and reports of nonconformity?
b.) Investigation of the cause of nonconformity and recording of the results?
c.) Determination of the corrective action needed to eliminate the cause of the
nonconformity? (occurrence, detection, systemic)
d.) Application of controls to ensure that corrective action has been taken and is effective?
(read across, lessons learned)
3. Do your preventive action procedures ensure:
a.) The use of appropriate sources of information (concessions, audit results, quality
records, etc.)?
b.) Determination of the steps needed to deal with problems requiring preventive action?
c.) Initiation of preventive action and application of controls to ensure it is effective?
d.) Relevant information on actions taken is submitted for management review?

Form #SSA-01 B
Revised 6/25/07
 SUPPLIER QUALITY SELF AUDIT & QUESTIONNAIRE FORM

K. LEAN MANUFACTURING YES N/A NO

1. Have you performed Value Stream Mapping to achieve efficient and optimal part processing?
2. Do you have a systematic approach to utilize and maintain Workplace organization?
3. Do you have a system in place to develop standardized work instructions (methods & sequence)
for all operations?
4. Is there systematic approach to develop Operator Instructions for all work performed?
5. Do you utilize mistake proofing/error proofing in your processes?
a. Is there a system in place to verify that error proofing/detection devices used in
manufacturing and assembly are functioning properly?
6. Is there a system in place to verify the documented manufacturing/assembly process through
layered audits?
7. Does your process automatically stop when a defect is detected?
8. Do you use Six Sigma metrics in your processes?

K. ADDITIONAL COMMENTS

The scoring process is dependent upon how many "No's" are accumulated and the severity of the "No".

Example: K8 = No Six Sigma data is currently collected. Data produced in Cost of Poor Quality, SPC, Corrective
Actions and Department Measurables is used for metric measurements. (This qualifies an acceptable
No).

________________________________________________________________________________

Form #SSA-01 B
Revised 6/25/07