首件样品检验报告

购货商(客户)/ BUYER (Customer)

首件样品检验原因

Reas on for in itial sample in specti on _新供应商new supplier

新零件n ew part

_ 规格更改changed specifications

_ 产品加工过程更改changed production process

_ 新的制造地new manufacturing location

产品长期停产>1 年exten ded in terrupti on of product

ion >1year 由供应商和客户共同核准的首件样品检验的规范，存放在

以下文档中

in specti on are con tai ned in the follow ing docume nts:

第1张共

Sheet 1 of sheet

供应商编号Supplier ID :

名称Name 填写"公司的英文或中文名及相应中文拼音"

Write “company name or in Chinese pinyi

地址Address 填写"公司地址"

接收人RecipienW rite

“

company adress“ -----------

部门Dept:填写“相关接收样品的部门”

write a recipient department name “姓名Name:填写“接收样品的人员姓名”

Write a recipient name “首件样品检验报告

In itial Sample In specti on

Report

外观批准报告(由品质部批准)

Appeara nce Approval Report (AAR by

quality)

尺寸检验报告材料检验报告

Dime nsion Report Material Report

性能检验报告

Function Report

零件编号.

Part No. 填写“图号"

Write “ part

签发日期

Date issued 填写报告日期

Write report date 零件名称

Desig nati on Write

“ . ”

part n ame

报告编号

Report No. 填写内部报告

编号Write report No

图纸版本

In dex:

参考

Refere nce

Write last FSR No

零件编号.

Part No.

签发日期

Date issued

零件名称

Desig nati

on

报告编号.

Report No.

模具编号填写模具编号模腔数目填写模腔数

Tool No. write “ mould No No. of cavities write “ cavity NO 样品数量

Quan tity of samples

备注

Remark

图纸版本

In dex

参考

Refere nce

检验结果见附表

实际尺寸见样品检验单

不合格的在“ AT ”栏中注明

违禁物质声明/Declaration of substances:

是/yes 否/no

REACH 禁用物质清单REACH candidate list(SVHC): no SVHC substances in a concentration>0.1%, reference 参见:

___ 是/yes | 否/no* ----- >* 签名/ Signature For in specti on results, refer to attached sheets:

The actual measureme nts are give n in order of the samples. Non-conforming

specificati ons are in dicated in the colum n "AT".

备注(供应商"Remarks (Supplier):

填写：

「此样品第几次送样；

2.所附加其它报告(如材质报告)，或其它报告见哪份FSR

Write: 1. Sample delivery times; 2. Attached report name

备注/Remarks (CEN):

1. Initial samples must be taken from 1~8 hours production with a minimum 300 consecutive parts, unless otherwise specified by CEN quality re除.非斯易安品质代表特别同意，首件样品必须1~8小时的量产，且规定的生产数量至少为300件连续生产的零件。

条件Conditions

我们供应商在此声明，

1. 所提交的样品是完全采用正常生产的原材料，按照正常批量生产的方

法生产的；

2. 样品检验准确结果如报告(偏差见附表) ，

3. 首件样品批准并不免除供应商按适用的图纸和规格交付产品的责任We hereby certify,

1. That samples submitted are completely made with regular production resources following regular series production methods.

2. The correct inspections of the samples and their listing in this report (deviations are shown separately).

3. That a sample approval does not relieve the supplier of his responsibility to deliver material according to the applicable drawings and specifications.

结论/Decision: 1=接收approv ed;2. 一定条件下接收approved with concession;3 拒收，交

重新送样new sample needed

I | 是yes

日期Date: .. .................................. . 部门Dept:

供应商/ SUPPLIER

The specifications jointly approved by the Buyer and Supplier for the initial sample