SUPPLIER DEVIATION REQUEST FORM

Supplier Name:
GHSP P/N Part in Launch Part in Production
Supply Chain Representative Product Deviation Process Deviation

Describe the specific deviation in terms of What, Where, How, How Many

Select GHSP Site(s) that are directly impacted

Grand Haven Hart Saltillo Shanghai North Shanghai South

Describe what caused the request to deviate

Describe the potential failure modes to GHSP (pull from PFMEA)

Describe the action plan to return the condition(s) back to the normal state, including an end date
ACTION OWNER DATE

Label each container with Deviation Approval # and expiration date

Confirm back to GHSP closure of Deviation
FOR GHSP USE ONLY
Reviewer Acknowlegement, the deviation is understood and the risk is necessary to accept
Product Deviations Process Deviations
Product Engineer Quality Engineer
Process Engineer
Quality Engineer

Deviation Approval
Product Approver(s) Date Process Approver(s) Date
Principal Engineer Purchasing Mgr
Process/Tech Mgr(s) PTR Yes
Required No
Quality Mgr (Prod)
Program Mgr (Launch)

SDE Mgr Aproval (both types) Date DA#

DA Extention Approval

VP Supply Chain Date

SC-FORM-132 Supplier Deviation Form 27May14

FOR GHSP USE ONLY
Reviewer Acknowlegement, the deviation is understood and the risk is necessary to accept
Product Deviations Process Deviations
Product Engineer Quality Engineer
Product Engineer Quality Engineer
Product Engineer Quality Engineer
Product Engineer Quality Engineer
Process Engineer Quality Engineer
Process Engineer Quality Engineer
Process Engineer
Process Engineer
Quality Engineer
Quality Engineer
Quality Engineer
Quality Engineer

Deviation Approval
Product Deviation Approver Date Process Approver Date
Principal Engineer Purchasing Mgr
Principal Engineer
Principal Engineer
Principal Engineer
Process/Tech Mgr
Process/Tech Mgr
Process/Tech Mgr
Process/Tech Mgr
Process/Tech Mgr
Quality Mgr
Quality Mgr
Quality Mgr
Quality Mgr
Quality Mgr