DESIGN VERIFICATION PLAN AND REPORT Copies must be verified for current revision

DVP&R No: Rev: Date:

System Description: Supplier Name:

Subsystem Description: Supplier Code: Affected Program(s): Team:

Assembly Description: Part Number Rev Design Engineer Supplier Design Engineer (Key Contact)
Supplier
Address:
Name: Name:

City: Zip / Postal

Component Description: Part Number Rev Code:
Title: Title:

State: Country:
Email: Email:

Test Stage ED = Engineering Development Test, DV = Design Verification Test, PV = Production Verification Test, CCT = Continued Compliance Testing Phone: Phone:
Target Requirements. State required probability and confidence of meeting criteria, e.g. R90, C90 or all must pass.
Sample Level A = Prototype (No tooling), B = Prototype (Soft Tooled), C = Production Tooling (Not Process), D = Production Tooling & Process Cell: Cell:

Planned Product Testing Reporting of Results Planned Test Timing & Sample information Actual Timing & Sample Information
Compliance / Scheduled Timing Actual Timing
Test #

Regulatory / Specification / Test Name Method or Procedure Duration Acceptance Criteria Test Results / Findings Test Results Test Completed by Notes Test Target Requirement Test Location / Source of Sample Level Sample Size Report or Doc. Sample Level Sample ID Sample Size
SC/CC/KPC Pass / Fail Stage Verification Resp. Requirement or Batch # Number Tested
Start End Start End

Verification Report Authorization Design Engineer Review / Approval

I affirm that the samples used for verification testing are representative of our parts, and I authorize the use of this data.

Authorized Signature Date Authorized Signature Date

Title Time Title Time

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