DESIGN VERIFICATION PLAN AND REPORT

Supplier Name Acme Suppliers Part Number Latest Version/ Changes Revision 00 Part Description Flat Glass

Specification & Method Test Description Acceptance Criteria Test Stage Target Requirements Sample Type Sample Level Actual Results Additional Notes
Specification Provide a brief Specify test targets and/or ED = Engineering Devel't Testing State required probability Describe the A = Prototype (Handmade) List results in terms Describe or
governing test description
of each test. pass/not pass criteria. DV = Design Verification or durability and confidence sample to be B = Prototype (Tooled) of reliability or elaborate on
& test method used PV = Production Validation of meeting acceptance tested (see C = Production Tool (Not Process) probability as appropriate sub-phases
(if applicable). CCT = Continued Compliance Test criteria sample level) D = Production Tool and Process

Test Plan Test Report

Test Specification Acceptance Test Notes Test Timing Est. Sample Timing Sample Pass/ Actual Additional
ID & Test Method Test Description Criteria Phase (Plan) Responsibility Start Comp. Qty Type Act. Comp. No. Level Not Pass Results Notes
247 Ball Drop Test steel balls 95% durability at 95% Miscellaneous notes
Test Lab AS
dropped from a DD/MM/ 1 P Pass Glass not
one meter height
XX time of usage durability related to planned test
YYYY DD/MM/YYY per
establ
P DD/MM/YYYY broken,
Notes Ref. No. NT/FG/BDT

ished found
plan satisfactory

Verification Report Authorization

I affirm that the samples used for verification testing are representative of our parts, and I authorize the use of the des.

Authorized Signature Title Date

QMS-F-0674
Rev. 1 Page 1 of
Doc. No.: GGC/D&D/06 - 00