1-4.10-FM-35, Rev. A
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2)
3)
4)
___________________________________________________________________
Revision: A
5)
Part Revision Level: Latest part revision that affects the part being first article
inspected. If there is no revision, indicate as such. Note: The latest drawing
revision (Field 7) does not always affect all parts contained on a drawing.
6)
7)
8)
9)
10)
12)
13)
14)
Full FAI or Partial FAI: Check as appropriate. For a partial FAI, provide the
baseline part number (including revision level) to which this partial FAI is
performed and the reason for it. For example, changes in design, process,
manufacturing location, etc.
15) 16) 17) and 18): This section is required only if the part number in Field 1 is an
assembly requiring lower level parts to be installed into the assembly.
15) (CR) Part Number: Detail or next level sub-assembly part number to be included
in the assembly.
16) (CR) Part Name, as shown on the drawing.
17) (CR) Part Serial Number of the part that is installed in the assembly, when
applicable.
18) (CR) FAI Report Number for detail part. Enter N/A if not used.
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Revision: A
6)
9)
10) (CR)
Certificate of Conformance number: Number of the certificate (e.g.,
special process completion certification, raw material test report number,
Standard Catalog hardware compliance report number, traceability number.)
For part marking, ensure that marking is legible, correct in content and size
and properly located, per applicable specification.
11) (CR) Test Procedure Number: Functional Test Procedure called out as Design
Requirement.
12) (CR) Acceptance Report Number: The functional test certification indicating
that test requirements have been met.
Signature Requirements
19)
Signature: name and signature of the person who prepared FAI Form. Also
check appropriate box if the FAI is complete.
Note: The signature box on this form certifies the following two things:
9a)
10)
11)
21)
8)
Records The original FAI documents will remain on file at the suppliers facility
for seven years, unless otherwise specified by contract.
Submittal Submit First Article Inspection (Pages 4 and 5) with the First Article
sample to Kollsman Inc. Reference Kollsman Product Assurance Provisions Clause
Code number 1.
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2. Part Name
Index of part numbers or sub-assembly numbers required to make the assembly noted above.
15. Part Number
Product Accountability for Requirements for Form Raw Materials, Specifications and Special Process(es), Functional
Testing
5. Material or Process Name
6. Specification Number
FAI complete
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2. Part Name
Characteristic Accountability
5. Char No.
6.Reference
Location (CR)
7. Characteristic
Designator (CR)
3. Serial Number
(CR)
Part
Rev.
Meth..
Rev.
Inspection/Test Results
8. Requirement
9. Results
9a.Accept/Reject
11. Non-conformance
No.