AMG Supplier Request (SR) for Deviation or Change
Document Number: COR-QF-0003
Page: 1 of 3
Revision Number: 6
Effective Date: Feb 23 2016
Supplier to Complete Page 1
Date Request Submitted: _______________________________________
Supplier Submission Number: ___________________________________
Requested Implementation Date: _________________________________
Check one:
[ ] Temporary Deviation
or
Supplier Name and Address:
[ ] Permanent Change
Supplier Code/Number:
Supplier Part Number / Description Affected by the Request:
(for temporary deviations, also include quantity of material covered by the deviation):
Category of Temporary Deviation or Permanent Change:
[
] PRODUCT DESIGN CHANGE
[
] COMPONENT / MATERIAL SOURCE CHANGE
[
] DISCREPANT MATERIAL
[
] MANUFACTURING PROCESS CHANGE
[
] COMPONENT / MATERIAL CHANGE
[
] MANUFACTURING LOCATION CHANGE
[
] TEST METHOD CHANGE
[
] OTHER (Provide details below)
Detailed Description of Change:
Sample of Changed Component to be Provided
[ ] YES
[ ] NO
Pre and Post Change Data to be Provided
[ ] YES
[ ] NO
AMG Supplier Request (SR) for Deviation or Change
Document Number: COR-QF-0003
Revision Number: 6
Page: 2 of 3
Effective Date: Feb 23 2016
Materion AMG to Complete Pages 2-3
ANALYSIS OF PROPOSED DEVIATION OR CHANGE:
-
Trial samples used in production:
-
Validation Testing completed:
-
Material Analysis completed:
-
Statistical Analysis completed:
Pre and Post Change Data Reviewed:
DEVIATION / CHANGE ACCEPTED: [ ]
DEVIATION / CHANGE ACCEPTED WITH QUALIFIYING CONDITION: [ ]
DEVIATION / CHANGE REJECTED: [ ]
DEVIATION / CHANGE IMPLEMENTATION DATE:
DEVIATION EXPIRATION DATE:
REASON FOR REJECTION OR QUALIFYING CONDITIONS OF ACCEPTANCE AND VALUE
TO AMG, IF ANY:
AMG Supplier Request (SR) for Deviation or Change
Document Number: COR-QF-0003
Revision Number: 6
Page: 3 of 3
Effective Date: Feb 23 2016
If the proposed deviation or change is approved, such approval is granted upon the
understanding that it is advisory in nature and in no manner changes the Seller's original
responsibility for ensuring that all characteristics, designated in the applicable engineering
specification and / or inherent in the samples as originally tested and approved, are maintained
and otherwise meet AMG’s specifications and other requirements. Seller accepts full
responsibility for the approved deviations, changes or types of changes listed above. Should
such changes result in less than satisfactory performance than that experienced with the
originally approved item, or AMG otherwise hereafter determines that the change does not meet
its requirements and/or specifications, Seller will immediately undertake to remedy including,
without limitation, fully reimburse the Buyer for all expenses incurred to correct the deficiency.
Nothing in this document or in the acceptance of any deviation or change proposed herein by
AMG shall be deemed to modify or otherwise relieve Supplier of any contractual obligation or
commitment of any kind or nature whatsoever.
MATERION AMG APPROVALS:
________________________________________________________________________
Engineering:
Printed Name, Signature and Date
________________________________________________________________________
Purchasing:
Printed Name, Signature and Date
________________________________________________________________________
Operations:
Printed Name, Signature and Date
________________________________________________________________________
Quality:
Printed Name, Signature and Date
The following approval is required if the Deviation or Change impacts Materion AMG’s
customer:
________________________________________________________________________
Sales & Marketing: Printed Name, Signature and Date