Supplier Deviation Request Form
To Be Completed by the Supplier
SUPPLIER/PART INFORMATION
Request Date:
Supplier Name:
Supplier Contact Name for Deviation:
TopWorx Part Number
Engineering Revision#
DEVIATION INFORMATION
Reason for Deviation Request: FIT: [☐] FUNCTION: [☐] MATERIALS: [☐]
OTHER: [☐]
Add reason here:
Description of Deviation: (Include number of parts deviation will affect)
Add description here:
Is Tooling Repair/Modification Required? YES: [☐] NO: [☐]
Cost Savings (piece price reduction) from Supplier to TopWorx.
Tooling Cost$:
To Be Completed by the TopWorx
Supply Chain Coordinator
DEVIATION EVALUATION AND DISPOSITION
Date:
APP[☐]
REJ[☐]
Supply Chain Manager
Date:
APP[☐]
REJ[☐]
Quality Manager
Date:
APP[☐]
REJ[☐]
Product Engineer
Date:
APP[☐]
REJ[☐]
Add Comments:
Deviation# (If approved, Supplier must list this number on all shipments)
Good Until
FRM-SDRF
R1 11/09/12