Company Information Industry Type CommercialNon-CommercialBoth Vendor Name Address City Country State/Province Zip/Postal Code Telephone:* Fax Prepared By Email Address Organization Structure Title Number of Employees Office Production Q.A. Others Facilities Layout Office Space Production Inspection Others History Years in Business: Type of Business Business Type:(Check all that applies) Broker/Surplus SupplierAir CarrierDistributorCertified ManufacturerRepair Station121/129 OperatorNon-121/129 Operato Quality Administration Is the quality manual/system organized in accordance with: Cert Cert. Number ISO 9000 Cert. Number AS9100 Cert. Number AS9110 Cert. Number AS9120 Cert. Number CASE Last Audited: (mm/dd/yyyy) ASA-100 Cert. Number AA-00-056B Cert. Number Other Government Standards: Compliance with ATA-300 or similar for packaging Does your facility have appropriate packaging materials that meet customer and industry specifications such as ATA-300? YesNo Inspection Stamp Control Is there a roster of supervisory and inspection personnel maintained with samples of signatures and stamps? YesNo Documentation Are all parts shipped with proper traceability to the last operator such as a 121/129 operator and include certification and linkage from all parties involved? YesNo Scrapped Parts Are scrapped parts/materials mutilated to prevent their inadvertent reuse? YesNo Material Procurement / Receiving Inspection Do receiving inspection procedures ensure that procurred material, components, and documentation are traceable to a prior source (e.g. 121 or 129 operator) and bear acceptable documentation that conforms to industry standards? YesNo Internal Audits Is there a procedure for monitoring the effectiveness of the quality system such as an internal audit and are corrective actions addressed accordingly? YesNo Environmental Controls Are parts requiring special environments identified and stored accordingly? YesNo Technical Data Control Are currently copies of applicable technical data and drawings and specifications available? YesNo Segregation Are commercial aerospace parts/material segregated from all other parts/material (e.g. miltary surplus, rejected parts, etc.)? YesNoN/A Recalls Is there a recall control system that ensures recall notification can be adequately circulated to appropriate parts that have been shipped? YesNo Shelf-Life Control Is there a shelf-life control system that assures that the quality and technical criteria are met for each part stocked that is identified as having shelf-life? N/AYesNo Hazardous Materials Handling Procedures Is there a system for hazardous material control and transport such as Title 49 of the Code of Federal Regulations (49 CFR)? N/AYesNo ICAO SMS/Human Factors Have all staff across your organization completed Human Factor training and is your company compliant with the ICAO SMS guidelines? HF onlyICAO SMSNO TO BOTHN/A COMMENTS AND SUGGESTIONS VENDOR QUALITY ASSURANCE SURVEY (TERMS & CONDITIONS) I certify that the information contained in this questionnaire is accurate to the best of my knowledge.I understand that willful misrepresentation of any information contained herein constitutes a material breach of contract.I understand that any breach of contract may result in disapproval as PowerJet Part's vendor and may void any existing purchased order(s).
