SUPPLIER PROCESS/PRODUCT CHANGE REQUEST (SPCR) FORM

PCN #:
Supplier Name:
Prepared by:
Contact Phone:
Contact email:
Date (MM/DD/YYYY):
PO#:
Comcode/Drawing #:
Attach marked up drawings or create links to referenced documents (e.g., Link_To_… ) by using Insert è Hyperlink on your toolbar

1. Requestor Information (Supplier)

/
Fill in with appropriate information or place an “X” next to those that apply: /
Type of Change: Tolerance
Temporary / [ ] / Permanent / [ ] / Requirements Doc Change [ ]
Material / [ ] / Process / [ ] / Specification [ ]
Sourcing / [ ]
Proposed Change Description and References: / Provide information below concerning the requested change. Create links to any supporting documentation.
Description:
Justification:
Hyperlinks:
or Drawing file names:
Impact of Not Implementing Proposed Change: / Unable to manufacture part
Alternatives: / Cancel order.

2. Review Results of the Change Request (Lineage Power)

/
Initial Review Date: (MM/DD/YYYY) / Assigned to:
Action / Comments
Approve for Impact Analysis / [ ]
Reject / [ ]
Defer Until (MM/DD/YYYY) / [ ]
Express Approval / [ ]

3. Impact Analysis (Lineage Power Component Engineering)

/
Baselines Affected:
Configuration Items Affected (e.g. product specifications):
Cost / Schedule Impact Analysis Required? (check one) / Yes [ ] / No [ ]
Impact on Cost:
Impact on Schedule:
Impact on Resources:
Risk associated with implementing the change:
Risk associated with not implementing the change:
Final Review Results:
Review Date: (MM/DD/YYYY)
Priority: (check one) / High [ ] / Medium [ ] / Low [ ]

4. Final Recommendation

/

5. SPCR Form / Signatures (Lineage Power)

/
Project Name:
Project Manager:
I have reviewed the information contained in this Supplier Process/Product Change Request Form and agree:

Name

/

Function

/

Signature

/

Date

(MM/DD/YYYY)
Component Engineer
Commodity Manager (Purchasing)
Design Engineer
Project Manager

The signatures above indicate an understanding of the purpose and content of this document by those signing it. By signing this document, they agree to this as the formal Process/Product Change Request Form.

Doc ID: / QP 7.4.4 / 3 OF 3 / 12/6/2012
Doc Type: / Quality Procedure / 6:29 PM
Doc Issue: / 2.2
UNCONTROLLED WHEN PRINTED or Transmitted Electronically
GE Power Electronics, inc. – Proprietary Information