FIRST SAMPLE REPORT
Cover Sheet
Production process and product approval report
DmbA Level: _______________________
Sample inspection
New part
Product modification (Specification M.)
Production transfer
Change in production procedures
Long production pause (> 12 M)
Tool modification /Tool adjustment
Change at purchased parts
Change the supplier
Other:______________________________
Re-sampling
First sample inspection
Test report other samples
Sender:
Appendices
01 Function test
02 Dimensional check
03 Material testing
04 Haptics
05 Acustics
06 Olfactory test
07 Appearance
08 Surface inspection
09 Electromagnetic compatibility [EMC]
10 Reliability test
11 Design – FMEA
12 Design approval
13 Process FMEA
14 Process Flow Chart
15 Control plan
16 Process capability evidence
17 Inspection and test equipment list
18 Evidence for inspection and test
equipment list
19 EU-Data safety sheet
20 IMDS
21 Means of transport / packing
22 Certificates
23 Process approval
24 Other:______________________
Supplier / Production location:
Customer:
Identification no. / DUNS-Code:
Test report no:
Subject no:
Part no:
Drawing no:
Change no:
Order/Call off date:
Identification no:
Test report no:
Subject no:
Part no:
Drawing no:
Change no:
Order/Call off date:
Delivery Note No /Date:
No of samples:
Charge no:
Sample weight:
Incoming Goods No /Date:
Delivery destination:
Supplier Confirmation:
It is hereby confirmed that the sampling has been carried out according to VDA Volume 2 chapter 4
IMDS-Data has been changed: IMDS-ID-No.: _____________________________
Name:
Comments:
Department:
Telephone:
Fax:
E-Mail:
_________________________________________
Date
signature supplier
Customer Decision:
total
According to Appendix
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Approved
Approved with conditions
Rejected new samples
required
Deviation concession no:
valid till:
Return: Delivery note no./ delivery date:
Name:
Department:
Telephone / Fax:
E-Mail:
Change index 2, valid since 8th Nov. 12
no of items:
date for new sample:
Comments:
____________________________________________
Date
signature
issued by: C. Behr 8th Nov. 2012
released: M. Herdner
FIRST SAMPLE REPORT
Content of the Report
Supplier / Production location::
Customer:
Identification no. / DUNS-Code:
Test report no:
Subject:
Part no:
Drawing no:
Change no / date:
Identification no:
Test report no:
Subject:
Part no:
Drawing no:
Change no / date:
Appendix
Level / Date
form, scale of operation and
identification of appendix
01 Function test
02 Dimensional check
03 Material testing
04 Haptics
05 Acustics
06 Olfactory test
07 Appearance
08 Surface inspection
09 Electromagnetic compatibility [EMC]
10 Reliability Test
11 Design – FMEA
12 Design approval
13 Process FMEA
14 Process flow chart
15 Control plan
16 Process capability evidence
17 Inspection and test equipment list
18 Evidence for inspection and test equipment list
19 EU-data safety sheet
20 IMDS
21 Means of transport / packing
22 Certificate
23 Process approval
24 Other
Supplier Confirmation:
Name:
Department:
Telephone:
Fax:
E-Mail:
__________________________________________
Date
signature
Change index 2, valid since 8th Nov. 12
Comments:
issued by: C. Behr 8th Nov. 2012
released: M. Herdner
FIRST SAMPLE REPORT
Product-related test-results
06 Olfactory test
07 Appearance
08 Surface inspection
09 Electromagnetic compatibility [EMC]
10 Reliability test
01 Function test
02 Dimensional Check
03 Material testing
04 Haptics
05 Acustics
Supplier / Production location::
Customer:
Identification no. / DUNS-Code:
Test report no:
Subject no:
Part no:
Drawing no:
Change no:
Identification no:
Test report no:
Subject no:
Part no:
Drawing no:
Change no:
Refno.
Actual value
supplier
Actual value
customer
Requirements /
Specification /
Tolerances
Complies
with
specification
yes
Supplier Confirmation:
Comments:
Notes
no
Customer Decision:
Approved
Rejected, new samples required
Comments:
Name:
Department:
Telephone:
Fax:
E-Mail:
_________________________________________
Date
signature
Change index 2, valid since 8th Nov. 12
issued by: C. Behr 8th Nov. 2012
Name:
Department:
Telephone:
Fax:
E-Mail:
__________________________________________
Date
signature
released: M. Herdner
FIRST SAMPLE REPORT
Process-related results and other
18 Evidence for inspection and test equipment list
19 EU-Data safety sheet
20 IMDS
21 Means of transport / packing
22 Certificate
23 Process approval
24 Other:_____________________________________
11 Design – FMEA
12 Design approval
13 Process FMEA
14 Process Flow Chart
15 Control plan
16 Process capability evidence
17 Inspection and test equipment list
Supplier / Production location:
Customer:
Identification no. / DUNS-Code:
Test report no:
Subject no:
Part no:
Drawing no:
Change no:
Identification no:
Test report no:
Subject no:
Part no:
Drawing no:
Change no:
Supplier Confirmation:
Comments:
Customer Decision:
Name:
Department:
Telephone:
Fax:
E-Mail:
_______________________________________
Date
signature
Name:
Department:
Telephone:
Fax:
E-Mail:
___________________________________________
Date
signature
Change index 2, valid since 8th Nov. 12
Approved
Rejected new samples required
Comments:
issued by: C. Behr 8th Nov. 2012
released: M. Herdner