Inspection Report Form

REPORT #

_____

CUSTOMER FIRST ARTICLE FIRST ARTICLE IN-HOUSE FINAL INSPECTION REPORT INCOMING INSPECTION CUSTOMER RETURN

INSPECTION RESULTS CUSTOMER:

PART #

REV:

DATE:

PO#

DATE CODE:

WO#

QTY RECEIVED

QTY ACCEPTED

QTY REJECTED

REWORK RE-INSPECTION

QTY ACCEPTED

QTY REJECTED

LEAD ASSEMBLER

ITEM

NOTES

SAMPLING PLAN USED DWG

DIM. &

ACTUAL

ZONE

TOL

Dimensions

INSPECTOR

ITEM

1

11

2

12

3

13

4

14

5

15

6

16

7

17

8

18

9

19

10

20

NOTES

TICKET#

DWG

DIM. &

ACTUAL

ZONE

TOL

Dimensions

Inspections Performed Mandatory

Acc

Rej

N/A

Additional Information

1.

Workmanship

6.

Part # label and date code

2.

Identification labels

7.

Pin-out

3.

Configuration & writing

8.

Traveler notes

4.

BOM correct parts used

9.

Special test

5.

Dress & orientation

10. Rework

COMMENTS

CUSTOMER APPROVAL: Form 8.2.5 Rev 4/8/05

Yes

No

By:

Acc

Rej

N/A