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Supplier Evaluation

Revision: a

FIELD NAME: FIELD VALUE:
Supplier Name		(List Commodity)
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	Other:
RESULTS OF EVALUATION

Supplier Qualified Supplier Conditionally Qualified Supplier Un-Qualified Dock-to-Stock
RESULTS OF RECEIVING INSPECTION OR FEEDBACK
PO#:		RFS/ICAR#:
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