1
dpIMPEX
Cover Sheet
Initial Sample Inspection Report
Supplier Information
Production process & product release report
Submission level:
Initial sample
New component
Product modification ( specification modification)
Production relocation
Modification in production process
Production suspension longer than 12 months
Tool modification / correction
Modification in purchased parts
Change of suppliers
Others
Resampling
New sampling
Reports other samples
Phone o
Fax no
email
www.dpIMPEX.se
Enclosures / Inspected
01 Dimension check
02 Function check
03 3D tooling design
04 Material test
05 Chemical test
06 MT, UT
07 Casting Sim.File
08 Surface HB
09 Surface inspection
10 Reliability test
11 Design-FMEA
12 Destructive test
13 Process-FMEA
14 Process flow chart
15 Production control plan
16 Process capability verification
17 Test equipment list
18 Inspection device capability
verification
Supplier / Production location:
19 EU-Safety data sheet
20 Material data sheet
21 Means of transport/packaging
22 Certificates
23 Process acceptance
24 Others
dpIMPEX
Cust.No. / Code:
Report no. / Index:
Name:
Part number:
Drawing number:
Status / Date:
Delivery note no. / date:
Delivery quantity:
Batch number:
Sample weight:
ID number or identification code:
Report no. / Index:
Name:
Part number:
Drawing number:
Status / Date:
Goods receipt no. / date:
Order no. / date:
Unloading site:
/
pieces
To be completed by dpIMPEX
To be completed by dpIMPEX
dpIMPEX confirmation:
We confirm that the sample inspections were performed in accordance with:
Specificaton
specification
Comments:
Department:
Phone / Fax / E-Mail:
Date:
dpIMPEX decision
Signature:
Single releases
Total
01
02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Approved
Approved with conditions,
resampling required
Rejected, resampling required
Deviation approval no.:
For returns, delivery note no. / date:
Name:
Department:
Phone / Fax / E-Mail:
Date:
Valid until:
Quantity
Resampling due date
/
Comments:
Signature:
Page 1 of 7
24
2
dpIMPEX
Cover Sheet
Initial Sample Inspection Report
Contents of the report
Status:
Supplier / Production location:
dpIMPEX:
ID No. /Code
ID number:
Report no. / Index:
/
Report no. / Index:
Name:
Name:
Part number:
Part number:
Drawing number:
Drawing number:
Status / Date:
Status / Date:
Enclosure
Status / Date:
Date:
Sheet:
/
of
To be completed by dpIMPEX
Type, extent and description of the enclosures
01 Dimension test
02 Function test
03 3D tooling design
04 Materials properties test
05 Chemical analysis
06 UT, MT
07 Casting Simulation file
08 Surface hardness test
09 Surface inspection
10 Reliability test
11 Design-FMEA
12 Destructive test
13 Process-FMEA
14 Process flow chart
15 Production control plan
16 Process capability verification
17 Test equipment list
18 Inspection device capability verification
19 EU Safety data sheet
20 Material data sheet
21 Means of transport / packaging
22 Certificates
23 Process acceptance
24 Others
Comments of supplier
Name:
Department:
Phone:
Fax:
E-Mail:
Date:
Signature:
Page 2 of 7
3
dpIMPEX
Cover Sheet
Initial Sample Inspection Report
Technical Material Package
Status
01 PDF Drawing
02 3D Drawing
03 DIN Specification
04 Requirements
05 Transport / packaging
Supplier / Production location:
ID No. /Code:
Report no. / Index:
Name:
Part number:
Drawing number:
Status / Date:
Ref. No.
Requirements / specifications
Date:
Sheet:
of
06 Marking
07 Delivery, terms and condition
08 Material Spec
09 Test Spec
10 Other
dpIMPEX:
ID number:
Report no. / Index:
Name:
Part number:
Drawing number:
Status / Date:
/
Supplier
actual values
Specification
met?
Yes
No
/
To be completed by dpIMPEX
Comments
Confirmation supplier:
Decision dpIMPEX:
Comments:
Approved:
Rejected, resampling required
Comments:
Name:
Name:
Department:
Department:
Phone:
Phone:
Fax:
Fax:
E-Mail:
E-Mail:
Date
Signature
Date
Signature
Page 3 of 7
4
dpIMPEX
Cover Sheet
Initial Sample Inspection Report
Tooling-related
Status
01 Casting sim file
02 3D tooling design
Supplier / Production location:
ID No. /Code:
Report no. / Index:
Name:
Part number:
Drawing number:
Status / Date:
Ref. No.
Requirements / specifications
Date:
Sheet:
of
10 Reliability test
07 Tooling inspection
DIN:
ID number:
Report no. / Index:
Name:
Part number:
Drawing number:
Status / Date:
/
Supplier
actual values
Specification
met?
Yes
No
/
To be completed by dpIMPEX
Comments
Confirmation supplier:
Decision dpIMPEX:
Comments:
Approved:
Rejected, resampling required
Comments:
Name:
Name:
Department:
Department:
Phone:
Phone:
Fax:
Fax:
E-Mail:
E-Mail:
Date
Signature
Date
Signature
Page 4 of 7
5
dpIMPEX
Cover Sheet
Initial Sample Inspection Report
Product-related
Status
01 Dimension test
02 Function test
03 Materials properties test
04 Chemical analysis
05 UT
Supplier / Production location:
ID No. /Code:
Report no. / Index:
Name:
Part number:
Drawing number:
Status / Date:
Ref. No.
Requirements / specifications
Date:
Sheet:
of
06 MT
07 Surface inspection
08 Surface hardness test
09 Destructive test
10 Other
DIN:
ID number:
Report no. / Index:
Name:
Part number:
Drawing number:
Status / Date:
/
Supplier
actual values
Specification
met?
Yes
No
/
To be completed by dpIMPEX
Comments
Confirmation supplier:
Decision dpIMPEX:
Comments:
Approved:
Rejected, resampling required
Comments:
Name:
Name:
Department:
Department:
Phone:
Phone:
Fax:
Fax:
E-Mail:
E-Mail:
Date
Signature
Date
Signature
Page 5 of 7
6
dpIMPEX
Cover Sheet
Initial Sample Inspection Report
Process-related and other documents
Status
Date:
Sheet:
of
11 Design-FMEA
18 Inspection device capability verification
12 Construction release
19 Casting Simulation file
13 Process-FMEA
20 Materials data sheet
14 Process flow chart
21 Means of transport / packaging
15 Production control plan
22 Certificates
16 Process capability verification
23 Process acceptance
17 Test equipment list
24 Others
Supplier / Production location:
dpIMPEX:
ID no. / Code:
ID number:
Report no. / Index:
/
Report no. / Index:
Designation:
Designation:
Part number:
Part number:
Drawing number:
Drawing number:
Status / Date:
Status / Date:
Confirmation Supplier:
Decision of dpIMPEX:
Comments:
Approved
/
To be completed by DIN
Rejected, resampling required
Comments:
Name:
Name:
Department:
Department:
Phone:
Phone:
Fax:
Fax:
E-Mail:
E-Mail:
Date
Signature
Date
Signature
Page 6 of 7
7
dpIMPEX
Name and
drawing no.
Cover Sheet
Simulation file no
Initial Sample Inspection Report
3D complete
Pattern
Cores totally
Total casting
weight
Material properties
Cast Metal
Alloys
Composition %
Mold
Sand
Coating
Binder
Molding process
Coating
Binder
Core process
Core totally
Sand
Others
Material
Chills
Coating
Pouring Process
Pouring Temperature ℃
Feeder
Exothermal
Insulating
Sleeves
Exothermal
Pouring time (S)
Insulating
Filter
Type:
Size:
Pouring rate kg/s
Any other information which might affect the sample please specify:
Page 7 of 7