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Request for Support

Revision: orig
REQUEST FOR SUPPORT
NONCONFORMANCE  CONTINUOUS IMPROVEMENT  CALCULATED RISK 
RFS No: 6 Date Prepared:
Item Name: Item Part No:
Drawing / Spec No: Item Rev:
Purchase Order# or Assignment Sheet#: Lot / Serial No:
Area Affected: Qty Affected:
Program Name: RFS Submitted By:
Job No: Traveler / Routing Name and Op No:
Description:
Send RFS To: Unit Cost, Each:
Measurement  Machine  Personnel  Material  Method-Process  Environment-Design  Documentation 
Root Cause:

Determine if problem exists elsewhere in the system:
Affect on Supplies:
Immediate Action, Responsibility, Schedule:
Corrective Action, Responsibility, Schedule or Special Instructions:
Preventive Action, Responsibility, Schedule or Special Instructions:
Trend?: Yes  No  Trend Details:
Yes ACN  No ACN;  Yes Supplement  No Supplement;  Yes ICAR  No ICAR;  Yes EO  No EO 
ICAR No: EO No:
CLASSIFICATION DISPOSITION - check all that apply
MAJOR SCRAP  RTV  WAIVER-DEVIATION  NON-STANDARD REWORK-REPAIR  NON-FLIGHT 
Minor Standard Rework  Conditional Acceptance 
None Precautionary  Clarification  Notification 
APPROVALS and EFFECTIVITY VERIFICATION
Review or Verify and Document Effectiveness of Action(s) Taken.

Record source of objective evidence (training records, revised procedures, etc):
REA:   Date:
Quality:   Date:
Referee (N/A if REA and QA agree):   Date:
Rework/Repair Operator: Date:
Rework/Repair Inspector: Date:
ACN=Advance Change Notice; ICAR=Investigation and Corrective Action Request; EO=Engineering Order