Key Safety Systems to Complete Below Temporary Deviation Number

Supplier Request for Engineering Approval

Commodity Affected: / Date Initiated:
Airbag / Seat Belt / Inflator / Supplier Ship to Location(s):
Steering Wheels / Other
Supplier Name: / Part Number: / Part revision:
Supplier Address: / Drawing Number: / Drw revision:
Description:
Supplier Signature:
Print Name & Title: / Tool/Cavity numbers:
Phone: / e-mail
Request type: Temporary Deviation Permanent Change (SREA); Affected type: Process Product/Print Procedure
Reason: Type detailed description here.
Number of Units or Request Duration: ______
Effective Date(s): / Request to Ship pending PPAP Approval
Expected PPAP submission Date: Level:
Required Page 2 Checklist Attached Q.R.Q.C. attached Other (describe)
Potential Quality Effect and Corrective Action
(Use attachments if necessary. Detail action, timing, and responsibility) : / Short Term Containment:

Key Safety Systems to Complete Below Temporary Deviation number #:

/ Completion Date :
Stock: Use Scrap QN issued? Yes No QN number# ______
Rework (send presentation with theproposed method, for KSS analyze/approval)
List All Key Safety Systems Locations Affected / Approval Signatures/Date Approvers: Indicate Approved/ Rejected/Conditional in shaded box
Plant Eng Mgr (req’d) / Plant QA Mgr (req’d) / Product Design (not mandatory) / Tooling/other(not mandatory)
Print Name and Date
Print Name and Date
Print Name and Date
Print Name and Date
Comments from Approvers (Please Initial):
If only Temporary Deviation requested, elevate for Permanent Change?: YES NO

Key Safety Systems to Complete Below Permanent Change (SREA) number#:

Drawings Customers Affected: / Tool
Drawings: Will be changed Drawing part no:
Will not be changed Drawing mod/rev:
ECP no: / Fix, completion date:
Replace,completion date:
Build capacity tool, completiondate:
P.O. number:
List All Key Safety Systems Business Teams Affected / Approval Signatures/Date Approvers: Indicate Approved/ Rejected/Conditional in shaded box
Engineering / Quality / Purchasing / Logistic / Tooling/Mfg.
Print Name and Date
Print Name and Date
Print Name and Date
Print Name and Date
Comments from Approvers (please initial):

Closure completion (SREA Board/Plant SQA)

Customer Approval Required: / YES NO
Customer Authorization Number: / add customer authorization number info / Customer Signature / Date
Final status decision of board: APPROVED REJECTED
Board comment:
Closure of SREA: / Signature of Authority/Title: / Date:

Required Page 2 SREA submission checklist:

Permanent Change’s (SREA)are defined as Permanent change requests to a print, part, or to obtain tooling decisions.

Temporary Deviationsare defined as Temporary authorizations to use a specific quantity of product or to use non-conforming product for a specified period of time and/or amount of units.

Very important: SREA’s (“Permanent Change”and/or “Temporary Deviation”) are to be submitted with evidence data to the Key Safety Systems plant SQA and cannot accompany a PPAP submission.

For additional info, please check SREA Procedure 1005107 KSS701, available under Key Safety Systems Inc. internet page

Part Number: / Prototype Pre-Production Serial Production

Reason for Request



/ Mandatory Documents & Information Required
Tooling issues:
Tool move
Legacy tool
New tool / 1)Number of hits on tool. Hits/Shots: ______
2)Cost of new or refurbished tool. $______
3)Timing to bring ‘fix’ on-line. PPAP Date: ______
4)Cavities or tools affected: ______
5)Summary of characteristics affected. Can be ‘Reason’, page 1.
6)Evidence of stability (previous parts, dimensionals, Cpk, etc.). ______
7)Print marked with desired changes and current actuals.
Inappropriate material specification(s) / 1)Reason for belief that the specifications are insufficient or inappropriate.
2)Effect on the component of a change of specification.
3)Quote any associated cost increase or decrease. $______
4)Recommended action(s).
Inappropriate drawing tolerance or nominal.
Incorrect cavity feature (1+ cavity different from the rest)
Measurement/feature geometry issues
Inadequately or poorly defined product feature / 1)Reason for belief in the insufficiency.
2)Reason why this is a problem. Provide history for review.
3)Quote to fix (if Key Safety Systems or OEM caused). $______
4)Summary of characteristics affected. Can be ‘Reason’, page 1.
5)GR&R study to support any submitted study (GR&R must represent the range of expected feature variation!).
6)Print marked with desired changes and current results.
Ship in advance of PPAP / 1)Full layout 1pcs. /cavity min. andmaterial certificate.

Full documentation is attached and is compliant to this checklist.

______

Supplier signature required above Date

Supporting documentation is confirmed as compliant with checklist and page 1 is entered in database:

Key Safety Systems SQA or SREA Administrator Date

SREA form 1017816 rev. 04 Page 1 of 2