Supplier Quality System Survey General Supplier DataCompany Name:Address: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone:Fax:Website: Person Completing Survey:Name/TitleSupplier CapabilitiesPlease describe all Key Processes/Capabilities/Products:List any 3rd party certifications (i.e. ISO, AS9100, Nadcap, etc):Attach any 3rd party certifications (i.e. ISO, AS9100, Nadcap, etc): Drop files here or Is this business a Distributor or Reseller?YesNoIf yes, is there authorization from original manufacturers to resell/distribute?YesNoPersonnelTotal # of EmployeesQuality ManagerName First PhoneEmail Calibration Service CapabilitiesOnly for calibration service providersYour calibration system complies with:ANSI/NCSL Z540-1-1994MIL-STD 45662ISO 17025No certificationDo your calibration standards have the required accuracy range, stability, and resolution for their intended use?YesNoAre calibration intervals established and maintained for calibration standards?YesNoIs the user notified of out-of-tolerance conditions found during calibration? If yes, how?YesNoExplain:Do you maintain a record system for each piece of customer equipment calibrated?YesNoQuality AuditingWill you provide the necessary personnel and equipment for HRL authorized representatives to verify all Quality concerns?Will you allow HRL authorized representatives to inspect and audit your Quality system?Will you permit HRL authorized representatives to conduct on-site Quality evaluations as required?Quality Management SystemDate and Revision of your Quality Manual:Which Standard is your Quality System based upon?Check if the following is addressed by your quality manual and/or procedures Management Reviews of QMS Organizational Chart Contract Review Corrective Actions Nonconforming Material Control Document and Data Control Purchase Control Process Control Receiving Inspection In-Process Inspection Configuration Management Counterfeit Parts Prevention Risk Management Supplier Performance Evaluation Shipping Inspection Internal Auditing Control of Customer Furnished equip. Storage, Packaging & Delivery Control Disposition Control Measuring & Test Equipment Control Personnel Competence Requirements Quality Records Control Statistical Process Control Final Inspection Foreign Object Debris Detection Flow Down Customer Req’ts to Suppliers Customer Feedback Process Control of Communications GIDEP SectionFor HRL Use OnlyGIDEP ReviewCompletedN/AQuality Approval Name Date Date Format: MM slash DD slash YYYY RemarksQuality Section: Scope: Chemical & Gases (CG) Process Materials (PM) Computer Hardware/Software (CS) Outside Services (OS) Processing Equipment (PE) Test Equipment & Tools (TE) Laboratory Operating Supplies (LS) Facilities / Maintenance (FM) Impact Level Code:Status:ApprovedRejectedLimted ScopeInvestigationalRemarksName First Date Date Format: MM slash DD slash YYYY Attachments Δ