SUPPLIER QUALITY MATERIAL REPORT
(SQMR)
This form is to be used when requesting acceptance by L-3 Combat Propulsions System (L-3CPS) of material containing minor
non-conformances that are not capable of rework to specification configuration. The request will be processed by the Supplier
Quality Assurance (SQA) Dept to obtain the necessary approvals allowing shipment of the described hardware with the defined
discrepancy.
Please fill out form completely and email to your L-3 CPS SQA commodity lead, commodity buyer agent and
cc: DLCPS-SQA@L-3com.com
DATE SUBMITTED:
PRODUCT AS DESCRIBED BELOW IS NOT TO BE
SHIPPED UNTIL AUTHORIZATION IS RECEIVED FROM
L-3 CPS SQA
SUPPLIER:
VCN NO:
PART NO:
CONTACT:
PHONE:
EMAIL:
P.O. NUMBER:
L-3 BUYER:
SPECIFICATION REQUIREMENT:
DEVIATION FROM SPECIFICATION:
ROOT CAUSE:
CORRECTIVE ACTION:
Short Term:
Long Term:
Note: If long term corrective action requires a Technical Data Package Change the Material Problem Report Number
must be attained from the Buyer and included in long term action.
NUMBER OF PARTS DISCREPANT:
DISCREPANT SERIAL NUMBERS:
NUMBER OF SHIPMENTS WHICH WILL CONTAIN DISCREPANCY:
BEGINNING DATE:
ENDING DATE:
USE ATTACHMENTS IF NECESSARY
ALLOW 2 WEEKS FOR PROCESSING
F-710-4
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SQMR FORM
INSTRUCTIONS FOR COMPLETING
1. SUPPLIER
2. VCN NO.
3. PART NO.
4. P.O. NUMBER
5. L-3 BUYER
6. CONTACT
7. PHONE NO.
8. E-MAIL ADDRESS
9. SPECIFICATION REQUIREMENT
10. DEVIATION FROM SPECIFICATION
11. ROOT CAUSE
12. CORRECTIVE ACTION
Enter the name of your company
Enter the "Supplier Number" from the top of the Purchase Order
(PO)
enter the L-3 CPS Part Number of the material being submitted
Enter the PO number
Enter the L-3 BUYER AGENT
Enter the name of the person in your organization who is
knowledgeable of the issue and may be contacted if necessary to
answer questions concerning the request.
Enter the complete phone no. for the contact (incl ext)
Enter the E-Mail address for the contact
State the drawing/spec requirement (with tolerance)
If more than one use alpha designators
State the out of tolerance condition for each designator.
State the cause for the out of tolerance condition for each
designator
Short Term Explain the immediate correction to preclude
additional product from containing the same discrepancy
associated with each designator
Long Term Describe the systemic closed loop correction (include
implementation dates) associated with each designator. Note: If
long term corrective action requires a Technical Data Package
Change the Material Problem Report Number must be attained from
the Buyer and included in long term action.
13. QUANTITY OF PARTS DISCREPANT
14. SERIAL NOS OF DISCREPANT PARTS
15. NUMBER OF SHIPMENTS WHICH
WILL CONTAIN DISCREPANCY
16. BEGINNING DATE
17. ENDING DATE
F-710-4
For each designator, list the quantity of parts discrepant
Enter the serial nos.of the discrepant parts if applicable
If at all possible, it is preferred the discrepant lot be shipped as a
single shipment.
Enter the anticipated date of the first shipment of discrepant
material.
Enter the anticipated date of the final shipment of discrepant
material.
NOTE: If approved for shipment, discrepant material must be
shipped as its own lot and not co-mingled with conforming
material.
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