Part Approval Warrant
Part Name:
Part No:
Drawing No:
Specification No:
TopWorx Purchase Order No:
Date:
Drawing Revision:
Specification Revision:
TopWorx Location:
Supplier Name:
Street Address:
City/State/Postal Code:
Country:
Buyer Name/Code:
Submission Information
Dimensional
Material
Functional/Performance
Type of Report for each item checked
Dimensional Inspection Results
Material Test Results / Certification
Functional/Performance Test Results
Reason for Submission
Initial Submission
Engineering Change
Tooling; Transfer, Replacement, Refurbishment or
other
Correction of a Discrepancy
Other - Please specify:
Material Change
Sub-Supplier or Material Source Change
Change in Part Processing
Change in Mfg. Location
Submission Results:
The results for:
Dimensional verification
Material test
Functional test
meet all drawing and specification requirements:
Yes
No. If No, please explain below.
Declaration:
I affirm that the samples represented by this warrant are
representative of our parts/service and have been made to
the TopWorx drawings and specifications and are made
from specified materials on regular production tooling with
no operations other than the regular production process.
Authorized Signature:
Title:
Tel:
Date:
Fax:
Email:
Part Disposition
TopWorx Controls Use Only
Approved
Approved with Conditions
Rejected, New tryout required
Rejected.
Supporting Comments:
Authorized Signature:
Date:
*If part contains certification markings or product ratings,
then TopWorx Certification personnel approval is required.
Yes
No
Authorized Signature: _____________________________
FRM-PAW
R2
Date: _______________
10/24/2013