Cover sheet ISIR (Initial Sample Inspection Report)
Supplier:
GANTNER
[Company Name]
GANTNER Electronic GmbH
[Street, Number]
[Postal Code]
Your company address
[City]
[Country]
Montafonerstr. 8
AT-6780
Schruns
Österreich
Reason for inspection
New part / Prototype
Change of production process
Product change
Relocation of production
New sub-supplier
Long production interrupt
mark
appropriate
selection(s)
Requirements of GANTNER
Scope and extent of inspection / attachements:
01 Functional test
04 EMC test
02 Dimensional check
05 Reliability test
03 Material test / Chemical checklist
06 Process capability
Supplier
mark
appropriate
selection(s) +
add
attachement(s)
07 Transport / Packaging
08 Certificate
09 Others
GANTNER
Code-No. Supplier:
supplier no. acc. order (see 1)
Parts list / Index.:
Code-No. GANTNER:
start
withReport
1;
your report no.
Insp.
No. / Vers.:
/
every
part description (see 2)
Part description:
additional
sample
(see 3)
Part No. / Rev.:
/ (see 4)
inspection of
like part no. except. drawing of third party
Drawing No. / Rev.:
the same part
date of release (see 5)
+1
Parts list / Index.:
in case of a complete unit
Modification No.
vers. of drawing (see 6)
Order Call-off No. / Date:
acc. order no. (see 7)
Delivery note No. / Date:
your delivery no.
Quantity delivered:
quantity
Batch No.:
Batch No::
your batch no.
Sample weight:
Sample weight:
acc. tested sample
Insp. report No. / Vers.:
Part description:
Part No. / Rev.:
Drawing No. / Rev.:
Status / Date:
/
/
/
/
Modification No.
/
/
Confirmation:
It is hereby confirmed, that the sampling has been carried out
according to VDA Volume 2 Chapter 4.
Incoming Goods No. / Date:
/
Quantity delivered:
According to scope
and extent:
Total
Decision
1
2
3
4
5
6
7
8
9
Released
Conditionally released
Your confirmation
Remarks:
Rejected, re-sampling
required
for possible comments from your side
Concession No:
filled by GANTNER
When returning
Delivery note No. / Date:
/
Remarks:
Name:
Your contact person
Name:
Department:
QM/QA
Department:
Telephone/Fax: Contact data incl. E-Mail address
Telephone/Fax:
E-Mail:
E-Mail:
Date
DK_GANTNER-ISIR-Fill-in-help-EN_V010000.xlsx
Created by/on: Angeli M./25.02.2015
Signature
Date
Modified by/on: ---
Signature
TlV03.01/DocV01.00
Released by/on: Wachter A.02.03.2015
Seite 1
Content of sampling documents
Supplier:
GANTNER
Code-No. Supplier:
supplier no. acc. order (see 1)
Code-No. GANTNER:
Insp. report No. / Vers.:
your report no.
Insp. Report No. / Vers.:
Part description:
part description (see 2)
Part description:
Part No. / Rev.:
(see 3)
/ (see 4)
acc. cover
like part no. except. drawing of third
party
sheet
Part No. / Rev.:
/
Drawing No. / Rev.:
Drawing No. / Rev.:
/
Parts list / Index.:
in case of a complete unit
Parts list / Index.:
/
/
Attachments
Status / Date
/
/
acc. cover
sheet
Type, extent and identification of Attachement
01 Functional test
02 Dimensional check
03 Material test / Chemical checklist
04 EMC test
05 Reliability test
06 Process capability
mark appropriate
selection(s) ;+
Status/Date of
attachement(s);+
07 Transport / Packaging
08 Certificate
09 Others
Remarks supplier:
Remarks:
for possible comments from your side
Name:
Your contact person
Department:
QM/QA
acc. cover
sheet
Telephone/Fax: Conact data incl. E-Mail address
E-Mail:
Date
DK_GANTNER-ISIR-Fill-in-help-EN_V010000.xlsx
Created by/on: Angeli M./25.02.2015
Signature
Modified by/on: ---
TlV03.01/DocV01.00
Released by/on: Wachter A.02.03.2015
Seite 2
Product related test results
Supplier:
GANTNER
Code-No. Supplier:
supplier no. acc. order (see 1)
Code-No. GANTNER:
Insp. report No. / Vers.:
your report no.
Insp. Report No. / Vers.:
Part description:
part description (see 2)
Part description:
Part No. / Rev.:
(see 3)
Part No. / Rev.:
/
Drawing No. / Rev.:
like part no. except. drawing of third
party
sheet
Drawing No. / Rev.:
/
Parts list / Index.:
in case of a complete unit
Parts list / Index.:
/
Ref.No.
/
/ (see 4)acc. cover
IST-value supplier
Requirements
/
IST-value GANTNER
Specifikation
complied
Part 1 Part 2 Part 3 Part 4 Part 5 Part 1 Part 2 Part 3 Part 4 Part 5
1
2
3
4
5
spec. dimension 1 incl. control limits
spec. dimension 2 incl. control limits
…
…
…
acc. cover
sheet
your measured value 1
Gantner measured value 1
your measured value 2
Gantner measured value 2
Yes
No
Mark appropriate
selection. In case
of No a
coordination with
the QA
department of
GANTNER
Electronic GmbH
is necessary
BEFORE sending
Send the ISIR report in advance by E-Mail to WE-Protokoll@gantner.com and the original ISIR report (incl. Signature(s) ) by post,
Confirmation supplier
Remarks:
Decision GATNER:
Released
Rejected, re-sampling required
Remarks:
Name:
Your contact person
Department:
QM/QA
Telephone/Fax: Contact data incl. E-Mail address
E-Mail:
acc. cover
sheet
Name:
filled by GANTNER
Department:
Telephone/Fax:
E-Mail:
Date
DK_GANTNER-ISIR-Fill-in-help-EN_V010000.xlsx
Created by/on: Angeli M./25.02.2015
Signature
Date
Modified by/on: ---
Signature
TlV03.01/DocV01.00
Released by/on: Wachter A.02.03.2015
Seite 3
Possible photo documentation
Description
Picture, graphic measurement results, thermoscan, ….
Example:
wrong hole diamenter; edges not
burr-free;
Possiblity of
documentation for
manufacturing
DK_GANTNER-ISIR-Fill-in-help-EN_V010000.xlsx
Created by/on: Angeli M./25.02.2015
Modified by/on: ---
TlV03.01/DocV01.00
Released by/on: Wachter A.02.03.2015
Seite 4
Purchase order "initial sample"
Max Mustermann
Gutstrasse8
6700 Bludenz
Österreich
7.
7.
3.
DK_GANTNER-ISIR-Fill-in-help-EN_V010000.xlsx
Created by/on: Angeli M./25.02.2015
Modified by/on: ---
TlV03.01/DocV01.00
Released by/on: Wachter A.02.03.2015
Seite 5
6.
5.
4.
2.
Drawing
3.
DK_GANTNER-ISIR-Fill-in-help-EN_V010000.xlsx
Created by/on: Angeli M./25.02.2015
Modified by/on: ---
TlV03.01/DocV01.00
Released by/on: Wachter A.02.03.2015
Seite 6