Initial Sample Inspection Report

• Manufacturer

• Address
  Address

• Quality Inspector

• Conducted on

  Date

General Information

• Part Name & Number

• Order Quantity

• Delivery Quantity

• Inspection Type

  Before serial production

  During serial production

• Reason for inspection during serial production

  Select New part Product change New sub-supplier Change of production process Relocation of production Long production interrupt

  • New part
  • Product change
  • New sub-supplier
  • Change of production process
  • Relocation of production
  • Long production interrupt

• Reason for inspection before serial production

  Sampling pre-production

  Prototypes

  Other

• Specify

• Scope and Extent of Inspection

  Select Cover sheet Dimensional check Inspection plan Process flow chart Material certificate Process capability Measurement capability List of test equipment Material safety data sheet Substances in purchased items Sales packaging Transport packaging Reliability test Approval/test reports Other

  • Cover sheet
  • Dimensional check
  • Inspection plan
  • Process flow chart
  • Material certificate
  • Process capability
  • Measurement capability
  • List of test equipment
  • Material safety data sheet
  • Substances in purchased items
  • Sales packaging
  • Transport packaging
  • Reliability test
  • Approval/test reports
  • Other

• Specify

Inspection Results

• Released

  Select Cover sheet Dimensional check Inspection plan Process flow chart Material certificate Process capability Measurement capability List of test equipment Material safety data sheet Substances in purchased items Sales packaging Transport packaging Reliability test Approval/test reports Other

  • Cover sheet
  • Dimensional check
  • Inspection plan
  • Process flow chart
  • Material certificate
  • Process capability
  • Measurement capability
  • List of test equipment
  • Material safety data sheet
  • Substances in purchased items
  • Sales packaging
  • Transport packaging
  • Reliability test
  • Approval/test reports
  • Other

• Released with stipulations (waiver required)

  Select Cover sheet Dimensional check Inspection plan Process flow chart Material certificate Process capability Measurement capability List of test equipment Material safety data sheet Substances in purchased items Sales packaging Transport packaging Reliability test Approval/test reports Other

  • Cover sheet
  • Dimensional check
  • Inspection plan
  • Process flow chart
  • Material certificate
  • Process capability
  • Measurement capability
  • List of test equipment
  • Material safety data sheet
  • Substances in purchased items
  • Sales packaging
  • Transport packaging
  • Reliability test
  • Approval/test reports
  • Other

• Rejected (re-sampling required)

  Select Cover sheet Dimensional check Inspection plan Process flow chart Material certificate Process capability Measurement capability List of test equipment Material safety data sheet Substances in purchased items Sales packaging Transport packaging Reliability test Approval/test reports Other

  • Cover sheet
  • Dimensional check
  • Inspection plan
  • Process flow chart
  • Material certificate
  • Process capability
  • Measurement capability
  • List of test equipment
  • Material safety data sheet
  • Substances in purchased items
  • Sales packaging
  • Transport packaging
  • Reliability test
  • Approval/test reports
  • Other

• Overall Disposition

  Released

  Released with stipulations

  Rejected

Completion

• Additional Comments

• Name & Signature of Quality Inspector

  Sign

• Name & Signature of Customer Representative

  Sign