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Source Surveillance / Verification

Vendor: Product / Service: Scope: Critical Characteristics to be Verified 1 2 3 4 5 6 7 8 9 10 Acceptance Criteria Sat/Unsat Date: Schulz Job #

CC #

Critical Characteristic Verification Method of CC Control Item Reviewed M&TE Used / Current?

CONCLUSIONS
Does supplier adequately control all identified critical characteristics? Yes No (explain any 'No's)

Performed by:
(name / title)

Date:

QA Manager Review & Approval:

Date:

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