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Supplier Evaluation

Revision: orig
Supplier Name
CHECK AT LEAST 3 BOXES IN PART II IF ONE ITEM CANNOT BE CHECKED IN PART I
Part I Sole Source  Customer Required  Customer Approved  Government Approved 
Part II Quality  Delivery  Cooperation  References  QA system certified  Regulatory compliance 
Part III On-Site Survey  Survey N/A 
RESULTS OF EVALUATION
Supplier Qualified  Supplier Conditionally Qualified  Supplier Un-Qualified  Dock-to-Stock 
RESULTS OF RECEIVING INSPECTION OR FEEDBACK
Results Acceptable - Supplier UNRESTRICTED  Results Poor - Supplier is RESTRICTED 
How critical is the item to the product or process? Critical  Non-Critical 
How critical is the Supplier? Critical  Non-Critical 
Level of confidence in Supplier per evaluations and data? High  Low 
How often are items purchased from Supplier? Daily  Weekly  Monthly  Yearly  Infrequent 
How complicated is the specification or standard? Easy  Difficult  Requires Supervisor 
Item accepted only by Supplier certification? Yes  In conjunction with product and/or process performance 
Supplier will be delegated inspection verifications? Yes  N/A