g GE Power & Water Sourcing Quality Forms

Supplier Deviation Request Form

SPS-PSSQMF-0190
Rev: 1.7
Supplier Deviation Request Form SPS-PSSQMF-0190
GE Power & Water Sourcing GSL Code Sequence #

(9 Char) (4 Char)
1. THIS SECTION TO BE COMPLETED BY SUPPLIER:

Non Conformance: (Description and reason for proposed Change) Supplier Ref #:
Buyer Name:
Buyer Code:
# Pages Attached:
Supplier Name:
Supplier Contact:
Phone #
Material Substitution
Fax #
From: Spec: To: Spec:
Date (DD/MM/YY):
Class: Class:
Purchase Order #: PO Line:
Other SDRs Submitted For This Part:
Qty. Def #
Dwg. # Rev. #:
Corrective Action: (action taken to prevent reoccurrence of
Dwg Name:
deviation)
Dev. Code: Cause Code:
C/A Ref. No: C/A Required (Y/N)
Design Change Req. For Future Orders :
Mat Spec #
Lot/Serial #:
2. DISPOSITION COMMENTS / SPECIAL INSTRUCTIONS Casting Serial:
Region:
GE Business:
SQE Name:
SQE Code:
SQE Location (Bldg* Room):
Eng Code:
Drawing Change Req. Field Mod. Required GEGS Code:
Turbine#:
Supplier Disposition Acknowledgment.
Model # / Framesize:
Name: Date:
Shop Order # :

GE PROPRIETARY AND CONFIDENTIAL UNCONTROLLED WHEN PRINTED Page 1 of 2

g GE Power & Water Sourcing Quality Forms

Supplier Deviation Request Form

SPS-PSSQMF-0190
Rev: 1.7

3. AUTHORIZATION:
OK REJECT SIGNATURE DISTRIBUTION NAME DATE

Product Services / /

Sourcing Quality / /

Design Engineering. / /

Materials Eng / /

Production Eng. / /

Manufacturing Eng. / /

Other (Specify) / /

4. DISPOSITION CODE: 5. C/A IMPLEMENTED: 6. SDR Close Date:

GE Power & Water Sourcing Quality Forms

Title: Supplier Deviation Request Form
Reference: SPS-PSSQMF-0190
Revision: 1.7
Application Date: 9/10/2013 3:17:56 AM
Expiration Date: 9/10/2016 12:00:00 AM
Author: Otto Zamek

GE PROPRIETARY AND CONFIDENTIAL UNCONTROLLED WHEN PRINTED Page 2 of 2