Form No.

: QSD FRM - 013

PSI AIR 2007, INC. VENDOR/SUPPLIER/SUBCONTRACTOR Issue - Rev. No.:
ASSESSMENT QUESTIONAIRE Date:

A. Company Details

Company Name :

Business Address :

State: Country : Postal Code:

Telephone No. :

Fax No. :

Email Address:

B. General Information

Type of Business (Check one)

[ ] Approved Maintenance Organization (AMO / MRO )

[ ] OEM / PMA Manufacturer / Support Services

[ ] Maintenance / Repair Station

[ ] CAMO Support Services ( Training, Data providers )

[ ] Part Distributor / Stockiest / Broker

[ ] Othe rs __________________________________

C. List of Primary Services Performed

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D. List of Sub – Contractors / Vendors and Capability
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E. List of Customers and Services Provided

CUSTOMER SERVICES PROVIDED
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2
3
4
5
F. Locations
Does the company have more than one facility? Y N If yes, state which countries / locations

G. Source(s) of Supply: (Please tick your choice, as applicable)

[ ] Original Equipment Manufacturer (OEM);

[ ] OEM – Licensed Sub-contractors;

[ ] Alternative source vendor approved by OEM;

[ ] NAA – Approved Sources;

[ ] Sources as defined in Military Qualified Product Lists (for AN, MS, NAS Standards);

[ ] Surplus Airline Inventory;

[ ] Other industry sources: _____________________________________________________ (Kindly specify)

H. Certificates / Authorizations

Is the company authorized by any aviation regulatory

authorities? YES NO N/A

If YES, list the certificate / authorization number and expiry date and attach copies of certificates.
NOTE: Please provide copy of certificates.

Aviation Regulatory Authority Certificate / Authorization No. Expiry Date

Have you ever been audited by any regulatory body or

customer previously? YES NO

If YES, when was the most recent audit concluded and by whom?

Date: _______________________________ Auditing Party : ___________________________________

I. Required Documents

Provide the following:

[ ] Relevant Approval / Certifications (Mandatory)

Please provide the following documents to the [ ] OEM’s Authorization, as applicable

questionnaire for the purpose of assessment and
approval grant. [ ] Company Capability List

[ ] Service Level Agreements / Contracts, as

applicable

Note: FAILURE TO PROVIDE REQUIRED DOCUMENTS [ ] List of Products Offered

SHALL CONSTITUTE DISAPPORVAL.
J. Key Personnel

Managing Director/President:

Tel. No.: Fax No.: Email Address:

Production Manager/Director:

Tel. No.: Fax No.: Email Address:

Quality Manager/Director

Tel. No.: Fax No.: Email Address:

Total number of employees: Number of Quality Dept. staff: Number of Production staff:

K. Facilities

Number of buildings: Total area of facility:

Are any repair/overhaul processes accomplished on the components

at any location other this facility?

YES NO

If YES, state location: _____________________________________________________________ (Kindly specify)

 HOUSING AND FACILITIES YES NO NA

1. Is the facility of adequate size to house all the necessary tooling, equipment,
material and parts to perform work?
2. Does the housing adequately protect parts, materials, and customer units
from damage, theft and/or contamination?
3. Is the environment appropriate to protect workers so that the quality of
workmanship is not impaired by physical efficiency?
4. Does the facility have adequate lighting?
5. Do shipping and receiving areas have adequate space, lighting, shelving,
security and fire protection?
6. Is there adequate and appropriate storage space to safely store customer's
shipping containers and protect them from damage?

7. Is the work area, including supervisors' offices, clean?

8. Are storage facilities separate from shop and work areas?

9. Are aircraft parts and components segregated from non-aviation parts and
material?
10. Does the facility provide adequate protection of parts in work? E.g.
Filtered air or clean room depending on type of part.
11. Temperature Control / Air Conditioning / Humidity Control?

12. Security?

AUDITOR’S NOTES:
 HOUSING AND FACILITIES Check as applicable
1. Workshop (Paint, Welding, Cleaning etc.)

2. Warehouse
3. Parts / Materials Receiving Area

4. Parts / Materials Shipping Area

5. Test cell (Engine/ Accessories)

6. Non-destructive Testing Area

7. Other Specialized Facility Required for the Ratings

8. Area Automatic Test Equipment (Avionics)

9. Technical Library

10. Tool Room(s)

11. Calibration Shop

12. Archive / Records Section

13. Is the facility owned or leased? OWN LEASE

PERSONNEL TRAINING AND QUALIFICATION YES NO NA

1. Does your company have a training policy or a documented training

program?
2. Does the training include all mechanics, inspectors and technical
supervisors?
3. Is formal and OJT training documented?
4. Does your company have an established continuous training (e.g.
through re-current training, medical examination, etc.) to ensure
currency of approvals?
What is the interval of recurrent training (Kindly specify)______________

5. Are inspectors required to be specifically certified? If

Yes, by whom? (Kindly specify) _______________
6. Does the company have a process to positively identify approved certifying
personnel?
7. Are there nominated inspectors approved to carry out specialized processes
(e.g. Welding, NDT, etc.)?
8. Are there nominated inspectors approved to issue Authorized Released
Certificates, Certificates of Conformity or equivalent, for new or reworked
parts?
9. Are training records maintained for each inspector and production staff?
What is the duration of storage? (Kindly specify) _______________

10. Does the quality department maintain a roster of signatures of authorization

holders?
11. Are personnel knowledgeable in CMM and regulatory manuals?
12. Are personnel using the required manuals at the work area?
AUDITOR’S NOTES:

MATERIAL & PARTS STORAGE INSPECTION AND CONTROL YES NO NA

1. Is there a specially designated area for handling in-coming parts?
2. Are procedures available for performing in-coming inspections? If
Yes, are records of in-coming inspections kept?
3. Are acceptable sampling procedures adequate to ensure quality?
4. Is there a quarantine area for rejected parts and materials awaiting
disposition?
5. Is there a system for material review and evidence of proper action taken
on non-conformance parts and materials? How long are records
retained? There (Kindly specify) _______________
6. Is there a clearly identified means of segregating discrepant in-coming
parts from serviceable spares?
7. Is there a system for segregation of serviceable and unserviceable and
unserviceable parts and materials?
8. Is there a system in place for batching of in-coming parts and allocating
batch numbers for traceability?
9. Are all parts stored in specifically identified and secure storage areas, with
restricted access?
10. Is there an acceptable procedure to identify customers’ parts?
11. Are parts& material properly protected from damage and deterioration?
12. Are flammable, toxic or volatile materials properly identified& stored?
13. Is there an environmental control for temperature, humidity and dust
condition exercised if applicable?
14. Is there a designated store available for temperature/humidity sensitive
parts/materials?
15. Are procedures available for monitoring and controlling life-limited
parts/materials?
16. Are there procedures in place for re-validating the life of shelf life expired
materials?
17. Do parts in bin match part number on bins?
18. Are oxygen and other high pressure bottles correctly identified and
stored?
19. Does the company have an Electrostatic Sensitive Devices (ESD)
Program?
20. Are sensitive parts and equipment (oxygen parts, O-rings, electrostatic
sensitive devices, etc.] properly packaged, identified and stored to
protect from damage & contamination?
21. Are facilities available for the handling of Electro-Static Discharge Sensitive
(ESDS) parts and equipment?
22. Are non-airworthiness parts (e.g. ground equipment) stored in the same
areas air worthiness parts?
23. Are records maintained for all parts issued out of the storage areas?
24. Are facilities available to ensure that all components and parts are
adequately packed to prevent damage, prior to shipping?
25. Does the company have a process that assures aircraft components
and parts are shipped in suitable containers that provide protection
from damage and, when specified by the OEM, ATA-300 or
equivalent containers shall be used?
26. Are there procedures for periodically inspection, testing of such parts and
assemblies (sorted for long duration) to prevent onset corrosion and to
ensure continued serviceability?

a. Description of work performed.

b. Date of work completion.
c. P a r t s used.
27. Do the work d. Tests results.
records contain
e. I d e n t i t y of person performing work.
these?
f. Identity of person inspecting work.
g. Si gnat ure , certificate number, and approval
certificate of person returning article to service.
28. Do the purchasing documents clearly specify precise identification,
relevant technical data, inspection requirement, life requirements and
certification requirements?
29. Are purchasing documents reviewed and approved for adequacy of
specific requirements prior to release?
30. Are vendor or subcontractors evaluated and approved prior to placement
of orders?
31. Is there a shelf life program for the control of parts and materials with life
limit such as rubber items, adhesive, sealants, paints, etc.?
AUDITOR’S NOTES:

SHELF LIFE PROGRAM YES NO NA

1. Is there a documented shelf life program?
2. Does the program list parts and materials that have shelf life limits?
3. Does the program assign program responsibility to a specific person by title?

4. Does the shelf item have the shelf life expiration limit displayed?
5. Is there an adequate system to assure that no item will be issued or used
past its expiration date?
6. Were items sampled for shelf life within limits?
AUDITOR’S NOTES:

NOTE: Traceability/Certificate of Conformance

All materials used in repair / overhaul of SIAEP’s components will require complete traceability
to an approved source named in the Approved Vendor / Supplier List, and include complete
disclosure regarding accident, incident, and other abnormal occurrences that the materials
may have been subjected to.

I HEREBY CERTIFY THAT THE INFORMATION THAT IS PROVIDED IN THIS QUESTIONNAIRE IS

COMPLETE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.

NAME (Print):
POSITION: ______
SIGNATURE:
DATE: _
 FOR PSI AIR USE ONLY
AUDIT REPORT NO. _____ )

( ) Accepted, without Site Audit.

( ) Provisionally accepted, pending Site Audit.

( ) Accepted, On-Site Audit.

( ) Rejected.

AUDIT SUMMARY / REMARKS:

QA Auditor(s): _____________ _____________

Signature: ____________________________Name:____________________________Date: _______________

Quality Director/ Manager: ________________________

Signature: ____________________________ Name:____________________________ Date:________________