<p>SUPPLIER SOURCE INSPECTION REQUEST </p><p>NOTE: Source inspection requests are to be requested by the supplier’s quality department personnel only and emailed to [email protected]. NOTE: All shaded fields are to be completed by BAE Systems SQA, QA Engineer or Cognizant Quality CAM.</p><p>Date requested: Date ready: </p><p>To: SQA: Information only Action required Procurement: Information only Action required QA Engineer or Cognizant Information only Action required Quality CAM: Other: Information only Action required Inspector: Information only Action required Name of requestor: Phone number: E-mail:</p><p>Purpose of visit: Comments: Security Clearance Required: Source Inspection Yes No Other (see comments) Supplier name: Company name of where the source inspection is to take place:</p><p>Address for this visit: Street: City, State, Zip: Supplier’s QA contact name: Phone number: E-mail:</p><p>P.O. number: Line: Quantity: Part number: HDW/DWG revision to which it was built:</p><p>Description: Special description codes:</p><p>Inspection type: New part or RMA: Witness sample: Was SVR requested: S/N: Choose one Choose one Yes No Yes No P.O. HDW part revision: P.O. DWG revision: QA Engineer: Promise date:</p><p>Order quantity: Balance due: Buyer: Inspection and QA codes:</p><p>QA notes:</p><p>Project: PDM HDW part revision: PDM DWG revision: SRC, TipQA source/receiver number:</p><p>Page 1 of 3 11-054 (29 Dec 15) SUPPLIER SOURCE INSPECTION REQUEST </p><p>P.O. number: Line: Quantity: Part number: HDW/DWG revision to which it was built:</p><p>Description: Special description codes:</p><p>Inspection type: New part or RMA: Witness sample: Was SVR requested: S/N: Choose one Choose one Yes No Yes No P.O. HDW part revision: P.O. DWG revision: QA Engineer: Promise date:</p><p>Order quantity: Balance due: Buyer: Inspection and QA codes:</p><p>QA notes:</p><p>Project: PDM HDW part revision: PDM DWG revision: SRC, TipQA source/receiver number:</p><p>P.O. number: Line: Quantity: Part number: HDW/DWG revision to which it was built:</p><p>Description: Special description codes:</p><p>Inspection type: New part or RMA: Witness sample: Was SVR requested: S/N: Choose one Choose one Yes No Yes No P.O. HDW part revision: P.O. DWG revision: QA Engineer: Promise date:</p><p>Order quantity: Balance due: Buyer: Inspection and QA codes:</p><p>QA notes:</p><p>Project: PDM HDW part revision: PDM DWG revision: SRC, TipQA source/receiver number:</p><p>Page 2 of 3 11-054 (29 Dec 15) SUPPLIER SOURCE INSPECTION REQUEST </p><p>P.O. number: Line: Quantity: Part number: HDW/DWG revision to which it was built:</p><p>Description: Special description codes:</p><p>Inspection type: New part or RMA: Witness sample: Was SVR requested: S/N: Choose one Choose one Yes No Yes No P.O. HDW part revision: P.O. DWG revision: QA Engineer: Promise date:</p><p>Order quantity: Balance due: Buyer: Inspection and QA codes:</p><p>QA notes:</p><p>Project: PDM HDW part revision: PDM DWG revision: SRC, TipQA source/receiver number:</p><p>BAE Systems SQA Supplier number: Open corrective actions:</p><p>BAE Systems QA Engineer or Cognizant Quality CAM BAE Systems QA Engineer or Cognizant Note: QA Engineer or Cognizant Quality CAM must have Source Quality CAM trip approval: Inspection Directions entered into TIPQA for all parts being Yes No inspected if trip is approved. Project/task code to be charged for labor: Project/task code to be charged for travel:</p><p>Commodity / Part Group (required) and Remarks:</p><p>BAE Systems Source Inspector Note: Inspector is responsible for completeness and accuracy of the completed form prior to scheduling source inspection with the supplier. Confirmed by: Source inspection date confirmed:</p><p>Page 3 of 3 11-054 (29 Dec 15)</p>