Deviation Request
Suppliers to complete areas with asterisk (*)
Key Fields
*Deviation Number:
DEV-
-
*Equipment/System Type
Deviation Point:
Job Number:
Deviation Initiator
Standard
Customer:
Custom
*Supplier:
*PO Number:
Internal:
*Quantity affected:
Comments:
Audit:
*Deviation Type
Labor:
Material:
Process:
Dimension:
Specification:
*Identification
Customer/Supplier/Internal:
Business location:
Originator:
Phone:
Description:
WT Part No.:
Procedure/Work Instruction & Revision:
Drawing No./Purchase Specifications, Revision & Date:
Date:
Email:
CAR No.:
Serial No / LOT No.:
Work Order/Job No.:
Test Specification/Method, Revision & Date:
Effective Date:
Final Date:
*Deviation Request Details
*Reason for Deviation / Root Cause / CAR
Records (check all that apply)
Documents (check all that apply)
Inspection Check Sheet
Process Flow Diagram
Operator Instructions
Lot Control Sheet
Other:
Other (define):
Other (define):
Other:
Other:
JSA
Other:
******Attach copies of updated records and/or documents with highlighted changes******
SAP Change
Document No.: TBD
Revision:
Page 1 of 4
Deviation Request
Update Production Order BOM (Bill of Materials)
Item(s) to Remove:
Yes
No
Item(s) to Add:
Training Acknowledgment (if required)
Signature of trained personnel:
1st Shift Supervisor:
2nd Shift Supervisor:
3rd Shift Supervisor:
Other personnel:
Approvals (Manager or designee)
Required
Signature
Approved
Signature
Quality Manager (required):
Customer Service:
M / E Engineering Manager:
Manufacturing Manager:
Materials Manager:
Purchasing Manager:
Project Manager:
General Manager:
Research & Development:
Date:
Date:
Date
Date:
Date:
Date:
Date:
Date:
Date:
Email this request and supporting documents to the Buyer listed on the PO.
INSTRUCTIONS FOR COMPLETING DEVIATION REQUEST
Document No.: TBD
Revision:
Page 2 of 4
Deviation Request
1.
General
The Deviation Request is used by the Customer or Supplier or internal Evoqua facility to document a request for
a product or process deviation or change to the process which was originally approved by Evoqua.
Upon completion, this form is to be sent to the Evoqua Buyer listed on the PO for processing.
2.
Instructions Suppliers are to complete all fields marked with an asterisk [*]
Key Fields
 *Deviation Number
i. Suppliers follow this format for deviation number: DEV-Supplier Name-date of deviation
ii. Evoqua – follow this format for deviation number: DEV-EWT Plant#-date of deviation
 Deviation Point – The point in the overall process where deviation will occur
 Job Number – SAP Project Number
 *PO Number – Purchase Order Number
 *Quantity affected – if applicable
 *Equipment/System Type – Standard or Custom product or process
 *Deviation Initiator – Source of the Deviation request
 *Deviation Type – Identify the part of manufacturing/fabricating the Deviation effects
*Identification
 Customer/Supplier/Process – Name of entity or requesting Deviation
 Date – Date when the Deviation Request is filed
 Business location of Requestor
 Originator – Person filing the Deviation Report
 Phone – Originator’s phone number
 Email - Originator’s email address
 Description – Brief description of request
 CAR No – Enter the CAR No if one is issued
 WT No – Evoqua part number effected
 Serial No / LOT No, - Serial or Lot number of part effected
 Procedure/Work Instruction & Revision – Entry required for Internal Deviation requests only
 Work Order/Job No.
 Drawing No./Purchase Specifications, Revision & Date
 Test Specification/Method, Revision & Date
 Effective Date – Date when the accepted Deviation will start
 Final Date - Date when the accepted Deviation will end
*Deviation Request Details – Fully describe the requested deviation from the current requirement/specification
or process.
*Reason for Deviation / Root Cause / CAR – Fully describe the reason for the deviation and the Root Cause. Also identify
the corrective actions to be taken to prevent a similar deviation in the future, if applicable.
Records - (check all that apply or add record if not listed)
Documents - (check all that apply or add document if not listed)
SAP Change – Identify changes required in SAP for this deviation
Document No.: TBD
Revision:
Page 3 of 4
Deviation Request
Training Acknowledgment (if required) - Personnel associated with process deviation must sign off when trained
Approvals (Manager or designee) – Signature of managers approving this specific Deviation request
Document No.: TBD
Revision:
Page 4 of 4