Contractor CAGE Code: 4V360 3550 General Atomics Ct San Diego, CA 92121-1122 SUPPLIER DISPOSITION REQUEST DR NO.: REV.: PAGE: of (3) PART NOMENCLATURE: (4) DWG/PART NO.: (5) REV.: (6) LOCATION: (7) DATE: (8) SUPPLIER NAME: (9) SUPPLIER ADDRESS: (10) MFR CAGE CODE: (11) GA-EMS BUYER: (12) P.O. NO.: (13) P.O. LINE : (14) LOT SIZE: (15) QTY INSP: (16) QTY NOT ACC.: (17) LOT/SERIAL NO.: (18) DISCOVERED IN: (19) INSPECTION CRITERIA: Receiving In-Process Final Other Design Document Inspection Instruction Other (20) REQUIREMENTS (21) NONCONFORMING CONDITION (22) PROPOSED DISPOSITION, CAUSE, AND CORRECTIVE ACTION (23) ATTACHMENTS: (24) PREVIOUS SDR/NR NO.: (25) INITIATOR: FOR GENERAL ATOMICS ELECTROMAGNETIC SYSTEMS USE ONLY (26) CONTRACT NUMBER: (27) HWCI PART NO.: (28) HWCI NOMENCLATURE: (29) WBS NO.: (30) PROJECT NO.: (31) SCHEDULE A NO: (32) CSI? YES NO (33) CLASSIFICATION: (34) ECR: NONCONFORMANCE: Critical Major Minor DESIGN CHANGE: Class I Class II INFORMATION ONLY: (35) DISPOSITION: (36) DISPOSITION & TECHNICAL JUSTIFICATION: Use-As-Is Repair Re-Work Scrap Information Only Modify (Design Change ONLY) ECR No: Date Issued:
SUPPLIER DISPOSTION REQUEST SDR No. Rev. (continuation page) AGE: FOR GENERAL ATOMICS ELECTROMAGNETIC SYSTEMS USE ONLY (Continuation Sheet) (37) CAUSE OF DISCREPANCY: (38) DEFECT CODE(s): (39) CAUSE (40) CORRECTIVE ACTION: (41) CORRECTIVE ACTION CODE(s): (42) CAUSE RESPONSIBILITY: (43) CORRECTIVE ACTION (BLOCK 44) VERIFICATION: GA-EMS: Supplier Other: (44) CAR REQUIRED? YES NO CAR No.: Date Issued: EFFECT INFORMATION: (45) EFFECT ON CONTRACT COST/PRICE: (46) EFFECT ON DELIVERY SCHEDULE: (47) EFFECT ON LOGISTICS SUPPORT, INTERFACE, OR SOFTWARE: GENERAL ATOMICS ELECTROMAGNETIC SYSTEMS SIGNATURES: (48) DESIGN ENGINEERING: (49) OTHER TECHNICAL: (50) ENGINEERING: (51) ENGINEERING MANAGER: (52) QUALITY ASSURANCE: (53) GA-EMS INTERNAL MATERIAL REVIEW BOARD (IMRB): CUSTOMER MATERIAL REVIEW BOARD: (54) GA-EMS CO-CHAIR: (55) CUSTOMER CO-CHAIR: DISPOSITION ACTION COMPLETED: (56) QTY ACC: (57) QTY NOT ACC: (58) NEW SDR/NR NO: (59) SUPPLIER OR GA-EMS INSPECTOR OR QA REPRESENTATIVE: (60) OTHER SIGNATURES (AS NEEDED) (61) GA-EMS QE VERIFICATION OF IMPLEMENTED DISPOSITION AND C/A SDR CLOSED
SUPPLIER DISPOSTION REQUEST SDR No. Rev. (continuation page) PAGE: of
Responsible Person Supplier 1 SUPPLIER DISPOSTION REQUEST (continuation page) PAGE: 4 Instructions to Supplier for Completing form EMS-0196 Supplier Disposition Request Block Title Description SDR No. & Revision Supplier 2 Page 1 of The SDR number consists of two parts. The first part is the GA-EMS PO number, and the second part is a three or more digit sequential number (for each PO) that is assigned by the supplier, who manages an SDR number log to avoid duplication or gaps. A letter is used to indicate subsequent revisions of the SDR. Fill in the total number of pages in the SDR, including continuation pages. Do not include the attachment pages; those are documented in Block (23). Supplier 3 Part Nomenclature Part Nomenclature from the drawing or specification. Supplier 4 DWG/Part No. Enter the Drawing Number of the Part that is nonconforming, requiring information, or design change suggestion. List the lowest level part number that the Supplier has. If no drawing number exists, then list the applicable specification number. Supplier 5 Rev. Revision of the Drawing or Spec. Supplier 6 Location Current physical location of the part. Supplier 7 Date The date of occurrence or discovery of the nonconformance, design modification, or information request. Supplier 8 Supplier Name The name of the organization on the GA-EMS PO. Supplier 9 Supplier Address The location of the manufacturing facility of the Supplier in Block (8). Supplier 10 Mfr CAGE Code Supplier's Contractor and Government Entity (CAGE) Code for the Manufacturing facility. Supplier 11 GA-EMS Buyer Name of the GA-EMS Buyer listed on the GA-EMS PO. Supplier 12 PO No. Enter the GA-EMS PO number. Supplier 13 PO Line Item Enter the PO Line Item(s) for the nonconforming part(s). Supplier 14 Lot Size Size of the Lot. Supplier 15 QTY Insp. Quantity of Items that were Inspected. Supplier 16 QTY Not Acc. Quantity of Items that were not accepted. Supplier 17 Lot/Serial No. Serial Number of nonconforming item, if applicable. If more than one Serial Number, enter "see Block (21) and include the Serial Numbers in the nonconformance description. If multiple nonconforming parts that are not serialized, attach temporary identification tags with "Unit 1," "Unit 2," etc., if necessary to clarify which nonconformance description applies to each unit. Supplier 18 Discovered in Check the box indicating the part of the manufacturing process in which the issue was discovered. For Other, specify the process. Supplier 19 Inspection Criteria Check the box indicating the type of criteria used to determine the issue. For Other, specify the criteria. Supplier 20 Requirements State the required condition, and note the applicable specification number and paragraph or drawing number and location. Describe it quantitatively, be complete, and be concise. Identify any interfacing items affected by the reported or proposed condition. For multiple items, give each a sequential item number in the Item column.
Responsible Person Supplier 21 Supplier 22 SUPPLIER DISPOSTION REQUEST (continuation page) PAGE: 5 Block Title Description Nonconforming Condition Proposed Disposition, Cause and Corrective Action Supplier 23 Attachments Supplier 24 Previous SDR/NR No. Identify the actual nonconformance, design modification, or information request. Describe it quantitatively, be complete, and be concise. Identifying any interfacing items affected by the reported or proposed condition. For multiple items, number them with the corresponding item numbers used in Block (20). Provide a clear, concise justification for any proposed changes. Identify any attachments submitted with the SDR. Include the attachment title and number of pages in each attachment. A repair procedure, including the method of verifying acceptability, is required for any repair dispositions. A design modification procedure, including a provision for acceptability verification, is required for any modification dispositions. Sketches or photographs are recommended to add to the clarity of the description of the nonconforming condition or design modification, or recommended disposition. Previous NRs/SDRs that apply to the item covered by the SDR and had similar causes and affected other items supplied to GA- EMS. Identify by NR/SDR number(s). Supplier 25 Initiator The originator shall sign as indicated. Supplier 56 QTY ACC Enter the quantity of items that are now accepted but were included in Block (16). Supplier 57 QTY NOT ACC. Enter the quantity of items that are still not accepted and were included in Block (16). Supplier 58 Supplier 59 NEW REPORT NO. Supplier Inspector or Supplier QA Representative If one or more items are still not acceptable, document on a new SDR form and list the SDR number here. Sign here to attest to the completion of the disposition actions and indicated quantities in Blocks (56) and (57). After the Supplier implements the GA-EMS-approved disposition, then forward the SDR to the Buyer listed on the Purchase Order.