HAZMAT Verification Check Sheet (HCSMS Version - 22) K0ZA Japan

Supplier Details K0ZA Part Name K0ZA Part No. PIC (Members) PIC Signature
Date :31-12-20

Supplier Name : Tube Products of India

Supplier (Plant) Code :

Plant Location :TPI Avadi,Chennai

S.No. Check Point Check Method Evidence Criteria Result

Requirement explanation to Suppliers Mail or other communication To be communicated Ok
Have you assur ed Latest HCSMS Version implementation at your T1/T2 supplier s? (If
Declaration of Suppliers Declaration(Any form of Confirmation) Should be Available ok
yes, then how?)
1 Genba Verification Records Should be Available ok

Have you done any additional confirmation for recent change points requirements at you
Communication and confirmation Mail or other communication and declaration/Gemba check Must be communicated and confirmed ok
and your Supplier s?(If yes, then how?)

Do you have HAZMAT Rule and HAZMAT Orgnization available in your plant? Availablity of Rule & HAZMAT Org. Rule & HAZMAT Org. Must be available ok

Is Roles & Responsibilities clear ly mentioned in Rule(Such as HCSMS handling &

Roles & Resp. in Rule/Org Rule & HAZMAT Org/any document Must be available ok
communication , IMDS Handling etc.)

Do you give any HAZMAT/HCSMS training/awar eness within your plant and to your
2 Training records/Mails/etc. Training Evidences Should be imparted ok
suppliers?

Do you have any inspection facility in you plant or third party testing available? Genba Verification Inspection M/C or Third Party testing Plan Available Should be available ok

If Inspection facilty available in your plant/third party then what is the fr equency of testing
Frequency check HAZMAT testing/Inspection plan Should be available ok
of your par ts?

Does the materials used for HMSI by You & Your supplier s comply with latest HCSMS Check IMDS and Label marking / MDS / Any Compliance of HCSMS and No Use
IMDS and Label sheet/Information of HCSMS ok
including New requirements? infor mation of HCSMS Hazar dous chemicals

3 Do you use any banned checmical (As per HCSMS) containing materials for other Any form of information Any form of information Must Control ok
customers?

Have you identified / Defined separate locations for Hazardous & non Hazardous mater ial Tagging or marking
Genba check Must Control ok
to avoid mixing control? Separate location

Do you use pr ohibited material in your manufacturing process Incl. Br ought Out Par ts;
Raw Material, Coatings, additives, Grease and oils etc. for HMSI parts ( Share Sur vey Genba check and PQCS, OPS Actual use in process,MDS No use ok
Sheet - A )

Is equipment / Line is common / separated for Hazardous & Non Hazardous mater ial Genba check Plan and records Share Contr ol cr iteria in case of use of ok
processing? pr ohibited for Other Customer

If line is seperated then Do you have any SOP or OPL/any document displayed at Critical Genba check SOP/OPL/Any document displayed at station Must Available ok
station?
4

If Prohibited material use in K0ZA model -- > Parts / Packing Material / Spares/
Consumables ( E.g. : Oil ; grease; Paint; Additives ; Agents etc.). Make Schedule Plan & replacement of material Both available
When and how to change mater ial for prohibited material free?

Ok

For K0Z A :- Spec Test completion in case of change point ( Supplier Self) Make Schedule Performance Report No Impact on Part Performance
ok

5 Plan for K0ZA Mass Production condition sustainability verification. As per PQCS or defined in standard Reports/Verification sheet/any document Should be available
ok
Comments
ok
 HAZMAT Survey check sheet ( Japan Laws ) Supplier Name :

Have you updated

Use for HMSI Use for other customers Actual use CAS
S.No. Substance CAS No. this substance in HMSI Remark
(Use /No use) (Yes/No) No.
IMDS? (Yes/No)

1 Asbestos Fibers, all members 77536-66-4,etc. No No No

2 Asbestos Minerals, all members 1332-21-4,etc. No No No
Lead (chemical compound), all members & Lead (metallic
3
form)
598-63-01, 8454-12-1,1319-46-6,7446-14-2,
15739-80-7, 7439-92-1,etc. No No No
4 Chromium(VI) -salts, all members 14977-61-8,etc. No No No
5 Mercury and its compounds, all members 7439-97-6　,etc. No No No
6 Cadmium and its compounds, all members 7440-43-9　,etc. No No No
7 Hexabromocyclododecane (HBCD) 25637-99-4 only No No No
8 Hexachlorobutadiene (HCBD) 87-68-3 only No No No
PCB
9
Polychlorinated biphenyls
16606-02-3, etc. No No No
PCN
10
Polychlorinated Naphthalene
70776-03-3, 1321-65-9,1321-64-8 No No No
11 Hexachlorobenzene(HCB) 118-74-1 only No No No
12 Bis(tributyltin)oxide(TBTO) 56-35-9 No No No
13 Mirex 2385-85-5 No No No
14 2-(2H-1,2,3-Benzotriazole-2-yl)-4,6-di-tert-butylphenyl 3846-71-7 No No No
15 2,4,6-tri-tert-butylphenol (TTBP) 732-26-3 only No No No
16 Bis(chloromethyl) ether (BCME) 542-88-1 No No No
17 Benzidine and its salts 92-87-5, etc. No No No
18 4-Aminodiphenyl and its salt 92-67-1,2113-61-3 No No No
19 4-Nitrobiphenyl (4-Nitrodiphenyl) and its salts 92-93-3 No No No
20 2-Naphthylamine and its salts 91-59-8, 553-00-4 No No No
21 DEHP (Bis (2-ethylhexyl) phthalate) 117-81-7 No No No
22 Phthalates DBP (Dibutyl phthalate) 84-74-2 No No No
(Other Law)
23 DIBP (Diisobutyl phthalate) 84-69-5 No No No
24 BBP (Benzyl phthalate) 85-68-7 No No No
PFOA Perfluorooctanoic acids C8F15O2H, its 335-67-1, etc
25
PFOA
(Other Law) salts, esters, higher homologues and precursor 3825-26-1, etc. No No No
all members 2043-53-0,etc.