PART SUBMISSION CHECKLIST

Purchase Order (PO) No.

Part Number: Part Description:
Print Revision Level: Reason for Request:
Supplier Name: Application:
Supplier Number:
Date Issued:
Submission Level
SUBMISSION REQUIREMENTS & DETAIL DESCRIPTION 1 2 3 4 5
** As found in Retention/Submission Requirements Table 4.2- AIAG PPAP Manual, 4th Edition **
Design Records R S S * R
For proprietary components / details R R R * R
For all other components / details R S S * R
Engineering Change Documents (ECN) - if applicable R S S * R
Customer Engineering Approval - as required R R S * R
Design Failure Modes Effects Analysis (DFMEA) R R S * R
Process Flow Diagram (PFD) R R S * R
Process Failure Modes Effects Analysis (PFMEA) R R S * R
Process Control Plan (PCP or CP) R R S * R
Measurement System Analysis (MSA) - Gage Repeatability & Reproducibility R R S * R
Dimensional Results of Samples - Must include all cavities or as required by SQE R S S * R
Material / Performance Test Results R S S * R
Initial Process Capability Study R R S * R
Qualified Laboratory Documentation (Example: A2LA lab certification ) R S S * R
Appearance Approval Report (AAR) - if applicable S S S * R
Sample Products For Layout (The quantity requested for submission is detailed on PO) R S S * R
Cosmetic / Styling Samples R S S * R
Master Sample - One Sample to be Identified as a Master Sample and Retained by Supplier R R R * R
Checking Aids (Fixture, gage, model, template, etc) - Specific to the part being submitted R R R * R
Records of Compliance with Customer-Specific - With Customer Specific Requirements as specified R R S * R
PSW - Part Submission Warrant (AIAG Form CFG-1001, Fourth edition or equivalent) S S S S R
Bulk Materials Requirements Checklist - if applicable S S S S R

UNLESS OTHERWISE SPECIFIED

S = Supplier Must Send Items for Approval by Customer

R = Supplier Retains Items at Their Facility for Review Upon Request by Customer.

* = Supplier to Send Items Upon Customer Request.

ADDITIONAL INSTRUCTIONS / COMMENTS:

1) PPAP submissions must arrive separately from engineering samples. Boxes should be sent to the attention of the appropriate Quality
Engineer & be labeled as PPAP submission

2) Use PPAP checklist as a guide to your submission for required documentation

3) Vendor may use their own internal forms if available ~ example documentation (PFMEA, CP, Dimensional, Performance ) included is
available as reference
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Part Submission Warrant
Part Name Part Number

Safety and/or Government Engineering Drawing

Regulation Yes No Change Level Dated

Additional Engineering Changes Dated

Shown on Drawing Number Purchase Order No. Weight (kg)

Checking Aid Number Engineering Change Level Dated

SUPPLIER MANUFACTURING INFORMATION SUBMISSION INFORMATION

Dimensional Materials/Function Appearance

Supplier Name

Customer Name/Division
Street Address
Buyer/Buyer Code

City State Zip Application

Note: Does this part contain any restricted or reportable substances? Yes No

Are plastic parts identified with appropriate ISO marking codes? Yes No

REASON FOR SUBMISSION

Initial submission Change to Optional Construction or Material
Engineering Change(s) Sub-Supplier or Material Source Change
Tooling: Transfer, Replacement, Refurbishment, or additional Change in Part Processing
Correction of Discrepancy Parts produced at Additional Location
Tooling Inactive > than 1 year Other - please specify

REQUESTED SUBMISSION LEVEL (Check one)

Level 1 - Warrant only (and for designated appearance items, an Appearance Approval Report) submitted to customer.
Level 2 - Warrant with product samples and limited supporting data submitted to customer.
Level 3 - Warrant with product samples and complete supporting data submitted to customer.
Level 4 - Warrant and other requirements as defined by customer.
Level 5 - Warrant with product samples and complete supporting data reviewed at supplier's manufacturing location.

SUBMISSION RESULTS
The results for dimensional measurements material and functional tests appearance criteria statistical process package
These results meet all drawing and specification requirements: YES NO (If "NO" - Explanation Required)
Mold / Cavity / Production Process

DECLARATION
I affirm that the samples represented by this warrant are representative of our parts, have been made to the applicable
Production Part Approval Process Manual 3rd Edition Requirements. I further warrant these samples were
produced at the production rate of ________ / 8 hours. I have noted any deviations from this declaration below.

EXPLANATION/COMMENTS:

Print Name Title Phone No. #REF! Fax No.

Supplier Authorized Signature Date

FOR CUSTOMER USE ONLY (IF APPLICABLE)

Part Warrant Disposition: Approved Rejected Part Functional Approval: Approved
Other Waived

Customer Name Customer Signature Date

July 1999 CFG-1001 The original copy of this document shall remain at the supplier' location Optional: customer tracking
F-QA-09-001 issue 1 while the part is active (see Glossary). number: # ______________
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POTENTIAL
FAILURE MODE AND EFFECTS ANALYSIS
Print # Rev. (PROCESS FMEA) FMEA Number:
Item: Process Responsibility: Prepared by:
Model Year(s)/Vehicle(s) Key Date Date (Orig.)
Team: Date (Rev.)
C Potential O D
Process Potential Potential S l Cause(s)/ c Current e R. Recommended Responsibility Action Results
Function/ Failure Effect(s) of e a Mechanism(s) c Process t P. Actions & Target Actions S O D R.
Require- Mode Failure v s of Failure u Controls e N. Date Taken e c e P.
ments s r c v c t N.

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CONTROL PLAN
Prototype Pre-Launch Production
Control Plan Number Key Contact/Phone Date (Orig.) Date (Rev.)

Part Number/Latest Change Level Core Team Customer Engineering Approval/Date (If Req'd.)

Part Name/Description Supplier/Plant Approval/Date Customer Quality Approval/Date (If Req'd.)

Supplier/Plant Supplier Code Other Approval/Date (If Req'd.) Other Approval/Date (If Req'd.)

MACHINE,
PART/ PROCESS NAME/ DEVICE, CHARACTERISTICS SPECIAL METHODS
PROCESS OPERATION JIG,TOOLS, CHAR. PRODUCT/PROCESS EVALUATION/ SAMPLE REACTION
NUMBER DESCRIPTION FOR MFG. NO. PRODUCT PROCESS CLASS SPECIFICATION/ MEASUREMENT SIZE FREQ. CONTROL PLAN
TOLERANCE TECHNIQUE METHOD

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Production Part Approval - Dimensional Results

SUPPLIER PART NUMBER Drawing Revision

NAME OF INSPECTION FACILITY PART NAME

ITEM DIMENSION/SPECIFICATION Gauge Used SUPPLIER MEASUREMENT RESULTS Gauge Used OK

SIGNATURE TITLE DATE

May 1995 CFG-1003

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NOT
OK

DATE

May 1995 CFG-1003

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Production Part Approval - Performance Test Results

SUPPLIER PART NUMBER Drawing Revision

NAME OF LABORATORY PART NAME

REF. TEST QTY. NOT

NO. REQUIREMENTS FREQ. TESTED SUPPLIER TEST RESULTS AND TEST CONDITIONS OK OK

SIGNATURE TITLE DATE

May 1995 CFG-1005

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