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SBG Form #0010 Revision: 01 Date: 02-06-13
Somaschini North America, LLc
4601 NIMTZ PARKWAY SOUTH BEND, IN 46628
Phone: (574) 968-0273 Fax: (574) 968-0278
Supplier Corrective Action Request
SCAR#
Submitter Name: ___________________ ___________________
First Last
Phone: :___________________ Date:
Att: Quality Control Manager Return Number:
This report of rejected material is brought to your attention for corrective action.
Part Name Part Number Job Number
Quantity
Received
Sample
Size
Samples
Rejected
Quantity
Rejected
Purchase
Order No.
Supplier
RGA#
The material identified above has drawn attention to the following defect(s):
Disposition
Return to Supplier
Sort / Rework at Suppliers Expense:
SCAR copy to Customer (Consigned Product)
Authorized by:
SCAR issued - Use as is
Sort / Rework Cost: $
Deviation Authorized $50.00Administration fee:
Deviation No.
Other:
Quality Approval: Operations Approval:
Date:
Date:
ORIGINAL: Q.A.
An 8-D must be initiated and completed through Step #3 (Containment) and returned to
Somaschini N.A. Within 24 hours from receipt of this Supplier Corrective Action
Request.
The 8-D has 15 calendar days to be completed. (Through closure of corrective action) A
copy should be returned to the Quality Assurance Manager at Somaschini North
America, LLC for verification and approval.
Internal Use Only - SCAR Closure
Response Date Initials Response
Yes - Close SCAR Log
Date Accepted Initials
Accepted?
No - Return to Supplier
COPY: MATERIALS MGMT.
Submit