SUPPLIER NON-CONFORMING MATERIAL REPORT NCR #

Yokohama Industries Americas 105 Kuhlman Blvd., Versailles, Kentucky 40383 Telephone: (859) 873-2188 Facsimile: (859) 873-8943

Supplier: Date: Inspector:

Part Number: Part Name Rev:
Date Received: PO / Work Order Number:
Quantity Received: Quantity Rejected:
Where found: All suspect material (fittings, components, assemblies)
In-process - Which Process: quarantined and tagged?
Other? Explain. Yes
Problem Classification: Points Assessed for NCR:

Frequency: Department affected by NCR:

Problem Description (brief):

Problem Description (detailed):

Suspect Vendor Lot Number(s):

Specification:
Actual :
Initial Disposition Quantity Final Disposition of Sorted Material Quantity
Use As Is Use As Is
Return to Vendor, RMA # Return to Vendor, RMA #
Sort/Repair Reworked "OK"
YIA - Expense Scrap
YIA - Supplier Expense
Supplier
Third Party Sort:
Other: Scrap Ticket Written?
Final Disposition Due Date Need Date (Internal/Customer) Sort / Rework Time Rate Sort Cost
$ 75.00 $ -
Supplier Quality Contact: Date Supplier Quality Contact: Date
Verbal E-mail Fax Verbal E-mail Fax
Corrective Action Requested:
Not Applicable Submit Short Term Corrective Action to YIA by:
Supplier to correct process Submit Permanent Corrective Action to YIA by:
YH AMERICA DEBIT / CREDIT MEMO
SCRAP - 100-54140 - BREAKDOWN TOTAL $ - SORT - 100-54230 - BREAKDOWN TOTAL $ -
Part # QTY UNIT/$ TOTAL Invoice Number Hours UNIT/$ TOTAL
$ - $ -
$ - $ -
$ - $ -

RETURNS - 100-12925 - BREAKDOWNTOTAL $ - MISC. - 140-62200 - BREAKDOWN TOTAL 0

Part # QTY UNIT/$ TOTAL Part # QTY UNIT/$ TOTAL
$ - $ -
$ - $ -
$ - $ -

ADMIN - 140-62000 TOTAL $ 250.00 SQE Approval_______________________ Debit X Credit

QC Manager Approval________________ TOTAL $250.00

YIA SQE Sign-off: Initial Disposition Date YIA SQE Sign-off: Final Disposition of Sorted Material Date

SQA-FM-0006 / VERSION 39.0

.
.
SQA-FM-0006 / VERSION 39.0
Sort / Rework Instructions:

Sort / Rework Information:

Date Time Lot Sorter Total Quantity Quantity Quantity Quantity

Number Sorted Accepted Rejected Reworked

Special Note:

CONTAINMENT WORKSHEET
SUSPECT VENDOR LOT NUMBER(s): 0
Location Potential Area Verified? Suspect Material Found Verification
Quantity yes / no yes / no Quantity Responsibility
IN TRANSIT TO CUSTOMER
SHIPPING STAGING AREA
RECEIVING AREA FITTINGS
RECEIVING AREA COMPONENTS
NIPPLE ROLL / MACHINING
PLATING AND IN TRANSIT
FITTING BEND / ACCESSORY
POWDER COAT
ASSEMBLY AREA
BONE PILE / BOX
FINISHED GOODS

Notes on Containment:

SQA-FM-0006 / VERSION 39.0

SUPPLIER CORRECTIVE ACTION REPORT
SUPPLIER: 0 1. TEAM
YIA PART NUMBER(S): 0 Leader:
TYPE OF CONCERN: CUSTOMER COMPLAINT NUMBER Members:
0 (if applicable):
DATE OPENED DATE CLOSED YIA SNCR NUMBER: (Non-conforming Report)
12/30/99 0
2. DETAILED DESCRIPTION OF PROBLEM 3. SIMILAR PART CONSIDERATION
Description 0 Can the concern appear on other parts? Describe.
Problem 0

4. INITIAL ANALYSIS 5. SHORT TERM CORRECTIVE ACTION

Where should the nonconformance have been detected? Yes No Describe actions taken to prevent the delivery of reject parts.
§ During process/manufacture FMEA, Router, OIS Actions must be taken and emailed within 24 Hrs. Responsibility
§ After manufacture (i.e. Final Inspection) Control Plan 1. Quarantine suspect parts
Reason for non-detection: 2. Certify stock (AT YIA)
3. Certify stock (supplier)
4. Verify in transit quantitys
5. Identify certified parts.
6. ROOT CAUSE AND 5 WHY ANALYSIS
Why Produced? Why Shipped?
1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
7. ACTION TAKEN TO PREVENT THE POSSIBILITY OF MAKING THE DEFECT
Why Made? What actions have been or will be taken to prevent the manufacture of reject parts in the future?
Action - Error proofing , Process Capability Improved, Revised Tooling or Process, Set-up Procedure Resp Target Date Completion

8. ACTION TAKEN TO PREVENT RECURRENCE OF SHIPPING THE DEFECT

Why Escaped? What actions have been or will be taken to prevent the shipping of the defective parts in the future?
Action - Poke Yoke, Auto Detection, Revised Gages, Improved Inspection Procedures Resp Target Date Completion

9. ACTION TAKEN TO PREVENT DEFECT OCCURRENCE APPLIED TO OTHER AREAS

Describe actions or similar actions applied to other products, processes and/or areas.

10. VERIFY PERMANENT PREVENTATIVE ACTION 11. FOLLOW-UP ACTION

How was / will the corrective action Date Verified Do any of the following require action as a result of this concern?
be verified as effective? Verified By Yes No Yes No
Drawing Work Instructions
FMEA Router / Traveler
Control Plan Tool layout / Job Card
Gages, Tools, Equip. Other
12. APPROVAL

QC MANAGER (SUPPLIER) DATE SQA ENGINEER (YIA) DATE

SQA-FM-0006 / VERSION 39.0
CORRECTIVE ACTION VERIFICATION REPORT
CAR NUMBER SUPPLIER: 1. TEAM
0 0 Leader: 0
TYPE OF CONCERN YIA PART NUMBER Members: 0
0 0 0
Date CAR Opened Date CAR Closed REFERENCE NUMBER 0
12/30/1899 12/30/1899 0 0
2. ACTION TAKEN TO PREVENT THE POSSIBILITY OF MAKING THE DEFECT
What actions have been taken to prevent the manufacture of reject parts in the future?
Action - Errorproofing , Process Capability Improved, Revised Tooling or Process, Set-up Procedure Resp Completion Verification
0 0 ###
0 0 ###
0 0 ###
0 0 ###
0 0 ###
3. ACTION TAKEN TO PREVENT RECURRENCE OF SHIPPING THE DEFECT
What actions have been taken to prevent the shipping of the defective parts in the future?
Action - Poke Yoke, Auto Detection, Revised Gages, Improved Inspection Procedures Resp Completion Verification
0 0 ###
0 0 ###
0 0 ###
4. ACTION TAKEN TO PREVENT DEFECT OCCURRENCE APPLIED TO OTHER AREAS
Describe actions or similar actions applied to other products, processes and/or areas. Verification
0
0
0
5. VERIFY PERMANENT PREVENTATIVE ACTION 6. FOLLOW-UP ACTION
Has the Corrective Action been implemented? If Yes, what has been done? Did any of the following require action?
If Yes, has it been done?
No Yes Ver
Drawing 0 0
FMEA 0 0
Control Plan 0 0
Gages, Tools, Equip. 0 0
Work Instructions 0 0
Internal Change Request
Other 0 0
Other
If No, what has not been done?

Is Corrective Action Effective?

Date Verified
Verified By

SQA-FM-0006 / VERSION 39.0

 CERTIFIED STOCK TAG

YIA PART NUMBER 0

PART NAME 0
NON-CONFORMANCE 0
YIA SNCR NUMBER 0

SORTED FOR:

SORTED FOR 0

SORT METHOD:(INCLUDE GAGE / FIXTURE DESCRIPTION, SIZE, ETC.)

CERTIFIED BY DATE CERTIFIED

SUPPLIER QC SIGN OFF PRINT NAME

SQA-FM-0006 / VERSION 39.0

MUST BE PRINTED ON GREEN PAPER

CERTIFIED STOCK TAG

YIA PART NUMBER 0

PART NAME 0
NON-CONFORMANCE 0
YIA SNCR NUMBER 0

SORTED FOR:

SORTED FOR 0

SORT METHOD:(INCLUDE GAGE / FIXTURE DESCRIPTION, SIZE, ETC.)

CERTIFIED BY DATE CERTIFIED

SUPPLIER QC SIGN OFF PRINT NAME

SQA-FM-0006 / VERSION 39.0

MUST BE PRINTED ON GREEN PAPER

 PARTS SORTED NO GOOD PARTS SORTED NO GOOD
SNCR # 0 PART # 0 SNCR # 0 PART # 0

QUANTITY IN THIS BOX: QUANTITY IN THIS BOX:

DEFECT DESCRIPTION / COMMENTS: DEFECT DESCRIPTION / COMMENTS:

DATE SORTED: DATE SORTED:

SORTED BY: SORTED BY:

(FULL NAME) (REPRESENTING) (FULL NAME) (REPRESENTING)

VENDOR: 0 VENDOR: 0
(MUST BE PRINTED ON RED PAPER) SQA-FM-0006 / VERSION 39.0 (MUST BE PRINTED ON RED PAPER) SQA-FM-0006 / VERSION 39.0

PARTS SORTED NO GOOD PARTS SORTED NO GOOD

SNCR # 0 PART # 0 SNCR # 0 PART # 0

QUANTITY IN THIS BOX: QUANTITY IN THIS BOX:

DEFECT DESCRIPTION / COMMENTS: DEFECT DESCRIPTION / COMMENTS:

DATE SORTED: DATE SORTED:

SORTED BY: SORTED BY:

(FULL NAME) (REPRESENTING) (FULL NAME) (REPRESENTING)

VENDOR: 0 VENDOR: 0
(MUST BE PRINTED ON RED PAPER) SQA-FM-0006 / VERSION 39.0 (MUST BE PRINTED ON RED PAPER) SQA-FM-0006 / VERSION 39.0
DATE: 12/30/1899 SORT / REWORK INSTRUCTIONS SNCR # 0

0 0 0
BASE PART NUMBER SORTED BY SORTED FOR (SUPPLIER)

SQE: 0 APPROVED BY: DATE:

DEFECT DESCRIPTION: 0

PICTURES OF DEFECT OR SORT CRITERIA IF APPLICABLE:

SORTING INSTRUCTIONS:

CLEAN POINT PART IDENTIFICATION INSTRUCTIONS:

SORTING PRECAUTIONS:

OTHER PART NUMBERS TO BE SORTED:

OTHER COMMENTS:

I ACKNOWLEDGE I HAVE READ AND

UNDERSTAND THESE INSTRUCTIONS:
SQA-FM-0006 / VERSION 39.0