DK Gantner I Sir Fill in Help Env 010000

Cover sheet ISIR (Initial Sample Inspection Report)
Supplier: GANTNER
[Company Name] GANTNER Electronic GmbH
[Street, Number] Montafonerstr. 8
Your company address
[Postal Code] [City] AT-6780 Schruns
[Country] sterreich
Reason for inspection

New part / Prototype Change of production process Requirements of GANTNER mark
appropriate
Product change Relocation of production selection(s)
New sub-supplier Long production interrupt
Scope and extent of inspection / attachements: mark

01 Functional test 04 EMC test 07 Transport / Packaging appropriate
selection(s) +
02 Dimensional check 05 Reliability test 08 Certificate
add
03 Material test / Chemical checklist 06 Process capability 09 Others attachement(s)
Supplier GANTNER
Code-No. Supplier: supplier no. acc. order (see 1) Code-No. GANTNER:
Insp. report No. / Vers.: your report no. / start withReport
Insp. 1; No. / Vers.: /
every
Part description: part description (see 2) Part description:
additional
Part No. / Rev.: (see 3) / (see 4) sample
Part No. / Rev.: /
inspection of
Drawing No. / Rev.: like part no. except. drawing of third party Drawing No. / Rev.: /
the same part
Status / Date: date of release (see 5) +1
Parts list / Index.: in case of a complete unit Parts list / Index.: /
Modification No. vers. of drawing (see 6) Modification No.
Order Call-off No. / Date: acc. order no. (see 7) / Incoming Goods No. / Date: /
Delivery note No. / Date: your delivery no. / Quantity delivered:
Quantity delivered: quantity Batch No.:
Batch No:: your batch no. Sample weight:
Sample weight: acc. tested sample According to scope
Confirmation: Decision Total and extent:
It is hereby confirmed, that the sampling has been carried out 1 2 3 4 5 6 7 8 9
according to VDA Volume 2 Chapter 4. Released
Your confirmation Conditionally released
Rejected, re-sampling filled by GANTNER
Remarks: required
for possible comments from your side Concession No:
When returning
Delivery note No. / Date: /
Remarks:
Name: Your contact person Name:

Department: QM/QA Department:
Telephone/Fax: Contact data incl. E-Mail address Telephone/Fax:
E-Mail: E-Mail:
Date Signature Date Signature
DK_GANTNER-ISIR-Fill-in-help-EN_V010000.xlsx TlV03.01/DocV01.00
Created by/on: Angeli M./25.02.2015 Modified by/on: --- Released by/on: Wachter A.02.03.2015
Seite 1
Content of sampling documents
Supplier: GANTNER
Insp. report No. / Vers.: your report no. / Insp. Report No. / Vers.: / /
Part No. / Rev.: (see 3) / (see 4) Part No. / Rev.: / acc. cover
acc. cover
Drawing No. / Rev.: like part no. except. drawing of third party
sheet Drawing No. / Rev.: / sheet
Attachments Status / Date Type, extent and identification of Attachement

01 Functional test
02 Dimensional check
03 Material test / Chemical checklist
mark appropriate
04 EMC test
selection(s) ;+
05 Reliability test Status/Date of
06 Process capability attachement(s);+
07 Transport / Packaging
08 Certificate
09 Others
Remarks supplier:
Remarks:
for possible comments from your side
Name: Your contact person

Department: QM/QA acc. cover
Telephone/Fax: Conact data incl. E-Mail address sheet
E-Mail:
Date Signature
Seite 2
Product related test results
Supplier: GANTNER
Insp. report No. / Vers.: your report no. / Insp. Report No. / Vers.: /
Part No. / Rev.: (see 3) / (see 4)acc. cover Part No. / Rev.: / acc. cover
sheet
Drawing No. / Rev.: like part no. except. drawing of third party
sheet Drawing No. / Rev.: /
Ref.- Requirements IST-value supplier IST-value GANTNER Specifikation

No. complied
Part 1 Part 2 Part 3 Part 4 Part 5 Part 1 Part 2 Part 3 Part 4 Part 5 Yes No
1 spec. dimension 1 incl. control limits your measured value 1 Gantner measured value 1
2 spec. dimension 2 incl. control limits your measured value 2 Gantner measured value 2
Mark appropriate
3 selection. In case
4 of No a
coordination with
5 the QA
department of
GANTNER
Electronic GmbH
is necessary
BEFORE sending
Send the ISIR report in advance by E-Mail to WE-Protokoll@gantner.com and the original ISIR report (incl. Signature(s) ) by post,
Confirmation supplier Decision GATNER:

Remarks: Released
Rejected, re-sampling required
Remarks:
Name: Your contact person Name: filled by GANTNER

acc. cover
Department: QM/QA Department:
sheet
Telephone/Fax: Contact data incl. E-Mail address Telephone/Fax:
E-Mail: E-Mail:
Date Signature Date Signature
Seite 3
Possible photo documentation
Description Picture, graphic measurement results, thermoscan, .
Example:
wrong hole diamenter; edges not

burr-free;
Possiblity of
documentation for
manufacturing
Seite 4
Purchase order "initial sample"
Max Mustermann
Gutstrasse8
6700 Bludenz
sterreich
7.
7.
3.
TlV03.01/DocV01.00
DK_GANTNER-ISIR-Fill-in-help-EN_V010000.xlsx Modified by/on: --- Released by/on: Wachter A.02.03.2015
Created by/on: Angeli M./25.02.2015
Seite 5
Drawing
2.
4.
5.
6.
3.
Seite 6

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Cover sheet ISIR (Initial Sample Inspection Report)

Reason for inspection

Scope and extent of inspection / attachements: mark

Name: Your contact person Name:

Date Signature Date Signature

Attachments Status / Date Type, extent and identification of Attachement

Name: Your contact person

Ref.- Requirements IST-value supplier IST-value GANTNER Specifikation

Confirmation supplier Decision GATNER:

Name: Your contact person Name: filled by GANTNER

Date Signature Date Signature

Description Picture, graphic measurement results, thermoscan, .

wrong hole diamenter; edges not

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