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Supplier Name:
Address:
City:
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Zip:
Head of Quality Organization:
Name:
Phone:
Fax:
Email:
Product or Service Provided:
Quality System Approvals: (If your organization is ISO 9000 or AS9100 registered, please provide a copy of the registration certificate, section A only and return. You must submit a certification to be considered registered.)
Certified:
AS9000/AS9100	ISO 9000
MIL-45208	NADCAP
Registration Certificate
Other(specify):
FAA Repair Station#:
Survey Completed by: (I certify the information supplied in this survey is true and complete.)
Name:
Title:
Date:
B. GENERAL
1. Is there a Quality manual? Yes No N/A 2. Is there a system in place to perform internal audits to assure an effective quality system? Yes No N/A 3. Is there a copy of Skurka Aerospace Inc Form P235 on file? Yes No N/A 4. If yes, what revision?
C. PROCUREMENT CONTROL
1. Are there written procedures for the control of purchased materials? Yes No N/A 2. Are certifications/test reports required from subcontractors? Yes No N/A 3. Are subcontractor surveys performed? Yes No N/A 4. Does the system provide for effective corrective actions with a subcontractor when required? Yes No N/A 5. Is there a flow down of customer requirements to the subcontractor? Yes No N/A
D. RECEIPT OF MATERIALS AND SERVICES
1. Are materials inspected to verify conformance with the purchase order requirements including receipt of certifications and/or test reports? Yes No N/A 2. Are receiving materials properly handled and protected during the receiving process and controlled to preclude removal prior to inspection? Yes No N/A 3. Is material controlled to prevent commingling and to ensure traceability throughout production/processing? Yes No N/A 4. Is periodic verification testing of raw materials performed by an accredited laboratory? Yes No N/A
E. SAMPLING INSPECTION
1. Is a statistical sampling plan utilized?, if not, attach a brief description of the sampling procedure used. Yes No N/A 2. Is the sampling inspection based on ANSI Z1.4 Mil-STD 105, or other generally accepted sampling plan? Yes No N/A
F. MEASUREMENT & TEST EQUIPMENT CALIBRATION CONTROLS
1. Is inspection and test equipment periodically inspected and calibrated? Yes No N/A 2. Are calibration standards traceable to N.I.S.T.? Yes No N/A 3. Is equipment identified as to calibration status? Yes No N/A 4. Is there a documented system for uniquely identifying the items to be calibrated? Yes No N/A 5. Is there an effective recall system in place with established calibration frequencies for measuring and test equipment? Yes No N/A 6. Does the calibration system conform to the requirements of ANSI/NCSL Z 540-1? Yes No N/A 7. Are employee owned inspection and test equipment included in the calibration recall system? Yes No N/A
G. STOCK & STORAGE CONTROLS
1. Are there written procedures for the control of stores and issuance of materials? Yes No N/A 2. Are materials received and maintained in the stock area properly identified as to inspection status? Yes No N/A 3. Is there a system to insure traceability both to receiving records and usage records? Yes No N/A 4. Is material stored in a manner so as to preclude damage or corrosion? Yes No N/A 5. Is there a system in place for the control and recall of age-controlled material? Yes No N/A
H. DOCUMENT CONTROL
1. Is there a formal document control procedure? Yes No N/A 2. Does the document control procedure include provisions for the control of customer documentation? Yes No N/A 3. Does the system provide for documented change control which will ensure that required drawing and specification change level is available at the point of manufacturing and inspection? Yes No N/A 4. Does the system provide for the control of software used in design, production, inspection, and/or test? Yes No N/A
I. IN-PROCESS CONTROLS
1. Are there adequate written work and/or inspection procedures at work stations and are they being utilized? Yes No N/A 2. Is there a "traveler" or similar document used for the sequence and control of operations and inspection points? Yes No N/A 3. Do in-process documents reflect drawing and/or specification requirements including change levels and are drawings and specifications available? Yes No N/A 4. Are in-process materials properly identified as to inspection status? Yes No N/A
J. INDICATION OF INSPECTION STATUS
1. Are stamps used to indicate status of material? Yes No N/A 2. Where stamps, signatures or initials are used, is a record maintained identifying the individual with the type of stamp and date of issuance, or a sample of the initials and/or signatures? Yes No N/A 3. Do Quality records include training and qualification of inspection personnel? Yes No N/A 4. Are records available for vision testing on personnel who perform visual inspection? Yes No N/A
K. PACKAGING AND SHIPPING
1. Are adequate controls provided to assure that all applicable inspection and test operations have been satisfactorily completed prior to shipment? Yes No N/A 2. Are materials designed for shipment properly identified and protected from damage during shipment? Yes No N/A 3. Is adequate control provided to assure chat all required documentation such as material certifications and test reports are forwarded with each shipment as required by contract? Yes No N/A
L. NONCONFORMING MATERIAL CONTROL AND CORRECTIVE ACTION
1. Are defective materials properly identified and segregated from acceptable material and held in a controlled area pending disposition? Yes No N/A 2. Is appropriate corrective action taken on non-conforming materials in accordance with the applicable standard? Yes No N/A 3. Is non-conforming customer furnished material identified as such and returned to the customer unless otherwise directed by the customer? Yes No N/A 4. Is customer promptly notified when it is discovered that discrepant product is already delivered? Yes No N/A 5. Does the system ensure that replies to customer requests for corrective action are made within the time specified by the customer? Yes No N/A 6. Is Quality sign-off required for discrepant material disposition? Yes No N/A
Verification Code

4600 Calle Bolero, P.O. Box 2869, Camarillo, California 93011-2869
Telephone: 805-484-8884 • Fax: 805-437-4082 • E-Mail: Quality@skurka-aero.com
Website: www.skurka-aero.com
  
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