Tracking #

SUPPLIER CHANGE REQUEST / REVIEW

Part Name
Part No./Chg. Level

Shown on chart #
Product Application Supplier Name Supplier Manufacturing Location & SAP ID
SECTION 1: CHANGE DESCRIPTION

Detailed Description of Change Proposal: Affects:

Yes No
(ANYONE CAN INITIATE)

Appearance
Cost/ Capacity
Drawing/ Dims.
Function
Key Prod. Char.
Mass
Material
Packaging
Process
Quality
Safety
Timing

Reason For Change: Reference PPR # (if applicable):

(THIS SECTION MUST BE COMPLETED FOR ALL ITEMS MARKED 'YES' IN ITEM #9. ATTACH DETAIL AS NECESSARY (See Instructions)
SECTION 2: CHANGE IMPACT

Impact change will have:

(SUPPLIER ONLY)

** ATTACH IMPLEMENTATION TIMELINE, CONTINGENCY PLAN, SKETCHES, DRAWINGS, ENG. PERMITS, etc. **
Signature: Submitted to:
(Supplier) Date:
For Further Details Firm PPAP
Supplier Contact: Phone: Submission Date:
Plants impacted
Krosno Cheb Luton Chihuahua Fangshan Shanghai Other
Signatures & Date of Decision
FUNCTION NAME & PHONE # APPROVED CR Number

Change Review Board Leader:

** If Approved: (one box must be checked)

Proceed with preparation of PPAP Submission as defined below (include copy of this form with PPAP submission)
NOTE - - This does not authorize production shipment incorporating change; authorization will be contingent on PPAP approval or
engineering permit.
- Subsequent ship requirements will be communicated through PC&L
PPAP Submission Not Required - Proceed with Change as defined below
SECTION 3: DISPOSITION

NOTE - Supplier must still update and maintain appropriate documents at their location
(BWI ONLY)

** If Rejected: (Reason for rejection)

Information to be Submitted / Actions Required: PPAP LEVEL -

PPAP Requirements: Implementation Requirements:
Part Submission Warrant Process Control Plan Pending Design/Process Validation
New Part Number Early Production Containment Pending Customer Approval
Print and Inspection Results Process Capability Studies Pending Production Trial Run
Appearance Approval Report Checking Aides On Site Audit
Sample Parts Gage Studies Early Production Containment
DFMEA Laboratory/Test Results/Specs Appropriate Packaging Forms
PFMEA Material Certification(s) Run at Rate Date
Process Flow Diagram Tier II Approval (Documentation Req'd) BWI Monitord Supp. Montitored
Engineering Permits Other Breakpoint Tag Required for Shipment
COMMENTS / CONDITIONS: by

CHANGE AUTHORIZATION SENT TO: Date:

(Supplier contact)

Rev 17-Mar-2016 BWI Supplier Change Request 310f1

 Date of Contact for
Rev # / Revision Description Tab Revised Revision Questions
0 / Initial Issue - Was previously maintained outside of CPP All 17-Mar-2016 DM Hudson

Rev 17-Mar-2016 Revisions 310f1