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Page
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NUMPAGES
4
Sender
CoverSheetVDAInitialSampleInspectionReport
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Productionprocess&productreleasereport
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DwSpA
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Submissionlevel:
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Initialsample
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Newcomponent
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Productmodification(specificationmodification)
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Productionrelocation
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Modificationinproductionprocess
Addressee
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Productionsuspensionlongerthan12months
BeijingBenz-DaimlerChrysler
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Toolmodification/correction
AutomotiveCo.,Ltd
No.8BoxingRd.BuildingNo.4,
5th.Floor,Economical–
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Modificationinpurchasedparts
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Changeofsuppliers
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Others
TechnologicalDevelopment
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Resampling
AreaBeijingChina,100176
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Newsampling
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Reportsothersamples
Enclosures/Inspected
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01Dimensioncheck
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07Appearancetest
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13Process-FMEA
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19EU-Safetydatasheet
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02Functioncheck
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08Surfacetest
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14Processflowchart
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20Materialdatasheet/IMDS
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03Materialtests
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09EMC-test
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15Productioncontrolplan
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21Meansoftransport/packaging
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04Haptictest
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10Reliabilitytest
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16Processcapabilityverification
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22Certificates
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05Acousticstest
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11Design-FMEA
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17Testequipmentlist
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23Processacceptance
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06Odortest
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12Constructionrelease
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18Inspectiondevicecapability
verification
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24Others
Supplier/Productionlocation:
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Customer：BeijingBenz-DaimlerChryslerAutomotiveCo.,Ltd
Cust.No./DUNS-Code:
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IDnumber:
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/
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Tobecompletedbycustomer
Name:
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Name:
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Drawingnumber:
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Status/Date:
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Status/Date:
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Deliverynoteno./date:
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Goodsreceiptno./date:
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Deliveryquantity:
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pieces
Orderno./date:
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Batchnumber:
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Unloadingsite:
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Sampleweight:
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Supplierconfirmation:
WeconfirmthatthesampleinspectionswereperformedinaccordancewithVDAVolume2,Chapter4.
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TheIMDSdatareportwascreatedunderIMDS-ID-No.:___________________________
Name:
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Comments:
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Department:
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Phone/Fax/E-Mail:
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Date:
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Signature:
Customerdecision
Total
Singlereleases
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Approved
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Approvedwithconditions,resamplingrequired
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Rejected,resamplingrequired
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Deviationapprovalno.:
Validuntil:
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Quantity
Resamplingduedate
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Forreturns,deliverynoteno./date:
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/
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Name:
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Comments:
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Department:
Phone/Fax/E-Mail:
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Signature:
ContentsoftheVDAreport Status:
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Date:
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Sheet:
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of
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Supplier/Productionlocation:
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Customer:
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IDNo./DUNS-Code
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IDnumber:
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Reportno./Index:
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/
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Tobecompletedbycustomer
Name:
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Name:
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Drawingnumber:
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Status/Date:
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Status/Date:
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Enclosure
Status/Date:
Type,extentanddescriptionoftheenclosures
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01Dimensiontest
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02Functiontest
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03Materialstest
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04Haptictest
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05Acousticstest
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06Odortest
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07Appearancetest
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08Surfacetest
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09EMC-test
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10Reliabilitytest
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11Design-FMEA
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12Constructionrelease
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13Process-FMEA
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14Processflowchart
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15Productioncontrolplan
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16Processcapabilityverification
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17Testequipmentlist
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18Inspectiondevicecapabilityverification
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19EUSafetydatasheet
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20Materialdatasheet
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21Meansoftransport/packaging
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22Certificates
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23Processacceptance
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24
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Others
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Commentsofsupplier
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Name:
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Department:
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Phone:
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Fax:
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E-Mail:
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Date:
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Signature:
Product-relatedtestresults Status
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Date:
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of
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01Dimensiontest
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06Odortest
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02Functiontest
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07Appearancetest
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03Materialstest
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08Surfacetest
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04Haptictest
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09EMC–test
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05Acousticstest
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10Reliabilitytest
Supplier/Productionlocation:
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Customer:
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IDNo./DUNS-Code:
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IDnumber:
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Tobecompletedbycustomer
Name:
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Drawingnumber:
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Status/Date:
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Status/Date:
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Ref.No.
Requirements/specifications
Supplieractualvalues
Specificationmet?
Comments
Yes
No
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Confirmationsupplier:
Decisioncustomer:
Comments:
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Approved:
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Rejected,resamplingrequired
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Comments:
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Name:
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Name:
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Department:
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Department:
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Phone:
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Fax:
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E-Mail:
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E-Mail:
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Date
Signature
Date
Signature
Process-relatedandotherdocuments Status
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Date:
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Sheet:
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of
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11Design-FMEA
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18Inspectiondevicecapabilityverification
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12Constructionrelease
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19EUSafetydatasheet
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13Process-FMEA
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20Materialsdatasheet
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14Processflowchart
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21Meansoftransport/packaging
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15Productioncontrolplan
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22Certificates
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