Supplier Audit Checklist(包材供应商稽核清单)

1. Supplier information (供应商) :Name (名称):

Status (状态):Location (供应商厂址):□ Initial (首次)Telephone (电话号码):□ Follow-up (跟踪)Fax #: (传真号码)

□ On-going (持续)Capital configuration(资本结构）Degree in industry(行业地位）Major customer (主要客户）Major equipment (主要测量设备）

□ Yes □ No □ Yes

□ No

3. Supplier Remarks (供应商备注):

4. Supplier Representative-Signature/Date (供应商代表-署名/日期):

Signature (署名):Date (日期):

5. Audit Status (稽核模式):

"A1" - Approved by site visit 参观工厂式评估□ Yes "AS" - Approved by self assessment 自我评估

□ Yes "CT" - Conditionally approved for Time 有时间条件地评估□ Yes "CL" - Conditionally approved for Limitatious 有限制条件地评估□ Yes "AW" - Approval Withheld 拒绝评估□ Yes "NR" - Not Rate 不用评估

□ Yes

6. Summary and evaluation of Audit (稽核总体概述及评价):

7. Conclusion (结论,参照第9项)Total Score (稽核得分):

Assess Grade (评定等级):

Audit Result (稽核结果):

8. Assessment -Signature/Date (评估-署名/日期):Assessor (评审员):Title (职务):Date (日期):Checked by (审核):Title (职务):Date (日期):Approved by (审批):

Title (职务):

Date (日期):

Notes(注): No. 1-4 items should be filled by supplier.（第1-4项由供应商填写）

Leviton Electronic (Dongguan) Co., Ltd.

立维腾电子(东莞)有限公司

2. Pre-Audit Mandatory Requirements (for initial audits only) 稽核的前提条件 :A. Does supplier conduct the QMS like as ISO 9001? 供应商是否导入质量管理体系(例如：ISO 9001)?

Supplier Audit Checklist

B. Does supplier agree to upgrade the system to meet the audit requirements? 供应商是否同意提升自身系统以配合稽核的要求?