Deviation Permit/Concession

DEVIATION PERMIT / CONCESSION (EXAMPLE) 1. DOCUMENT IDENTIFICATION

1.1. Identification of customer:

1.3. Document Reference number :

1.2. Identification of supplier / subcontractor: Supplier Code:

1.4. Document Issue:

1.6. Number of Sheets:

Supplier Name:

Sheet

2. IDENTIFICATION OF PRODUCT AFFECTED 2.1. Model of product / program: 2.2. Part number:

Drawing Issue:

2.3. Part Description: 3. DESCRIPTION OF NON-CONFORMITY Serial Number

1.5. Category: Customer # :

Supplier #:

Qty.

DWG. Ref. Sheet / Loc.

3.1.

2.4. Part Serial Number / Batch / Effectivity Number / Lot Number: 2.6. Product Number:

Detailed description of the non-conformity

MAX.

2.8. Assembly Serial Number:

2.7. Work / Purchase Order Number:

2.9. Assembly Drawing Number:

5. DISPOSITION OF NON-CONFORMITY 5.1. MRB / Design Decision:

Defect Characteristics / Specified Requirements NOMINAL

2.5. Quantity:

of

MIN.

ACTUAL DIMENSION

Quality Decision:

Previous Submissions of a similar nature:

Previous Submissions to actual item:

5.2. Limitations imposed on the part:

4. DESCRIPTION OF CAUSE / CORRECTIVE ACTION

COMPLETE BELOW FOR CATEGORY 1 CONCESSIONS ONLY Are any of the following adversely affected? Material Structure of Properties: Yes / No Life: Interchangeability: Yes / No Functioning or Reliability: Maintainability: Yes / No Suitable for Spares: HEALTH & SAFETY AFFECTED Yes / No Effect to Customer on Cost / DELIVERY: 6.

ORIGINATOR

DESIGN

Name: Signature: Date:

SABRe: July 2012 Revision

QUALITY

CUSTOMER 1

Yes / No Yes / No Yes / No

Affected / Not Affected

CUSTOMER 2

CONTINUATION SHEET (EXAMPLE) 1. DOCUMENT IDENTIFICATION

1.1. Identification of customer:

1.3. Document Reference number :

1.2. Identification of supplier / subcontractor: Supplier Code:

1.5. Category: Customer # :

Supplier #:

1.4. Document Issue:

Supplier Name:

Sheet

2. IDENTIFICATION OF PRODUCT AFFECTED 2.1. Model of product / program: 2.2. Part number:

Drawing Issue:

2.3. Part Description:

2.4. Part Serial Number / Batch / Effectivity Number / Lot Number: 2.6. Product Number:

2.5. Quantity:

2.7. Work / Purchase Order Number:

8. DISTRIBUTION LIST: 3. DESCRIPTION OF NON-CONFORMITY Serial Number

Qty.

DWG. Ref. Sheet / Loc.

3.1.

Detailed description of the Non-conformity

Defect Characteristics / Specified Requirements NOMINAL

MAX.

MIN.

5. DISPOSITION OF NON-CONFORMITY 5.1. MRB / Design Decision:

ACTUAL DIMENSION

Quality Decision:

SABRe: July 2012 Revision

1.6. Number of Sheets: of

2.8. Assembly Serial Number: 2.9. Assembly Drawing Number:

CONTINUATION SHEET (EXAMPLE) 1. DOCUMENT IDENTIFICATION

1.1. Identification of customer:

1.3. Document Reference number :

1.2. Identification of supplier / subcontractor: Supplier Code:

1.5. Category: Customer # :

Supplier #:

1.4. Document Issue:

Supplier Name:

2. IDENTIFICATION OF PRODUCT AFFECTED 2.1. Model of product / program: 2.2. Part number: 2.3. Part Description:

SABRe: July 2012 Revision

1.6. Number of Sheets: Sheet

Drawing Issue:

2.4. Part Serial Number / Batch / Effectivity Number / Lot Number: 2.6. Product Number:

2.5. Quantity:

2.7. Work / Purchase Order Number:

of

2.8. Assembly Serial Number: 2.9. Assembly Drawing Number: