Report Number (for PFI use only) Date:

Customer Complaint
Part number: Customer:
Rejected quantity: Lot number:

Description of Complaint
Reason for complaint Noise O Internal clearance O Grease leakage O

Durability O Fit/Finish O Oxidation O Packaging O

Describe complaint:

Describe equipment where bearing was installed (type, brand, model, etc):

When was problem detected? Receiving inspection O

Assembly O Initial run-in O Normal use O Other _______________________
How long was the bearing run?
Assembly method: manual O hammer O press O heat induction O
Environment: dust O humidity O corrosive O extreme temperature O
Speed (RPM): Operating temperature: Operating loads: shock O constant O
Housing: Dimension ______ Tolerance _______ Material ______
Shaft: Dimension ______ Tolerance _______ Material ______
Is bearing available for inspection? Yes O No O
If the bearing is not available for inspection, please describe the reason (If the bearing is not returned to PFI, an
inspection report cannot be issued):
Destroyed O Discarted O Lost O
Customer comments and suggestions:

Identified by (Name, Date):

Please return this form together with the bearing in question
to your PFI distributor. Thank you for your choice of PFI
Bearings.

The fields below are for PFI use only

Date: DISPOSITION Due Date:
Inspection Report No.:
PROBLEM IS: Founded O Unfounded O
IF FOUNDED, ROOT CAUSE:
INTERIM ACTION TAKEN:
PERMANENT ACTION TAKEN:
Approved (Title, Sign, Date): Approved (Title, Sign, Date):

Due Date: CLOSEOUT

Reinspected Yes No Inspection Report No.:
Corrective Action: Yes No Corrective Action No.:
Approved (Title, Sign, Date) Approved (Title, Sign, Date)

Form 13-01 rev. D (English)