XYZ Corp.

Supplier Evaluation Survey

Supplier Name Supplier Address
Street Number / Name / PO Box Number

Date

Supplier Rep.
Please Print City State Zip

Supplier Rep.Title Supplier Rep. Signature Quality System Certified to Date Certification Received Certificate on File
Distributor On Customer Approved Source List Customer Yes No

Phone Fax E-mail Quality Manager Registrar

Source List Dated

XYZ Company requires all Vendor/Subcontractors to become certified to an ISO Quality System Standard. Products produced for XYZ shall meet the requirements of QS 9000 TE, as well as any customer requirements. XYZ's assistance is always available to help you in achieving these goals. The outcome of these endeavors will be beneficial to everyone involved through higher quality products and continued business relations. If you are third party certified, are a distributor, or are listed on our Customer's Approved Source List, you do not need to complete the rest of this survey, please attach certifications as appropriate and any significant awards and return this document to XYZ's Purchasing Department. Please check the appropriate box, YES, NO or N/A (not applicable). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Do you have formal, documented policies, procedures and work instructions for quality related issues? Does your Executive Management periodically review your Quality System? Does your business plan include benchmarking? Are formal responsibilities defined for personnel performing work affecting product quality? Do you have an advanced quality planning procedure / process? Do you apply Reliability and Maintainability principles? Do you have an on-going continuous improvement effort? Do you have procedures for reviewing contracts and purchase orders? Do you have design capability? Software? Do you perform design verification? Do you perform design validation? Do you use statistical techniques (e.g.: SPC) to verify product characteristics and process capabilities? Do you have a system to control quality related documents? Do you have a system to evaluate your subcontractors? Do you have a system for controlling Customer Supplied Product? Do you identify products and maintain traceability throughout all stages of production, storage, and shipment? YES NO N/A

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XYZ Corp.

Supplier Evaluation Survey

Supplier Name YES NO N/A

Date

Supplier Address Please check the appropriate box, YES, NO or N/A (not applicable). 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 Do you have processes in place to control your manufacturing process? Is there a formal inspection and test procedure for incoming material? Is there a formal in process and final inspection program? Is there a formal inspection and test procedure for outgoing material? Do you document pre-shipment inspection of product? Do you require any tooling to be calibrated? Are records of calibration schedule maintained? Do you identify / control nonconforming product? (tag and segregate?) Do you have a corrective action program? Does your corrective action program utilize documented Root Cause Analysis? Do you have a written procedure for handling, storing, packaging, preservation and delivery of product? Is there a system to control quality records? (internal and customer related) Is there an internal auditing program? What training do your internal auditors receive? Is there a policy or procedure to identify training needs of employees? Do you have a servicing process in place? Are trends such as on-time shipments, percentage of orders filled, customer satisfaction tracked? Do you have a process for knowing what the Customer Requirements are? Do you have a customer complaint program?

Thank you for your cooperation Notes

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XYZ Corp.

Supplier Evaluation Survey

Supplier Name

Date

Supplier Address Subcontractor Exceptions / Waiver Specifics Documentation Area -For Internal Use Only
Mom and Pop Shop
PROCEED TO INTERNAL QUALITY OPERATING SYSTEM SECTION

# Employees

Part of a Large Corporation

Yes

No

Internal Quality Operating System In Process Toward Certification IQS Audit By XYZ Audit Scheduled Audit Completed Audit Notes / Evidence Complete and on File in Purchasing Department Use with Conditions Request To Customer For Sanyo To Conduct Second Party Audit (Non Mom and Pop Shop) Request Made To (Customer Representative) Notes of Verbal Request and Written Request on File At Sanyo Date Audit Scheduled Request To Audit - Approval From Customer Received Authorization on File at Sanyo Date IQS Completed / Documented Audit Notes / Evidence Complete and on File in Purchasing Department
Findings Acceptable Findings NOT Acceptable

Yes Registrar

No

Date Certification Expected

Findings Acceptable
Findings NOT Acceptable

Date Requested

Use with Conditions Request Required To Customer to Add Subcontractor to Approved Source List Request Sent To Customer Requested From and Date Sub-Contractor Approval Rec'd From Whom and Date Request Denied XYZ's Reason to Use Subcontractor without being Added to Customer Approved Source List

Certified Minority Supplier (Regional Council) PURCHASING DATABASE UPDATED

Certificate on File at Sanyo

Expiration Date

Recommendations / Notes

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