1300698835 VIR_W02801 r1 .docx

J:\LIBRARY\FORMS

NUWCDIVNPT TAHE FACILITYPhone: 401.832.3069 Fax: 401.832.3937 email: ronald.f.hodge@navy.mil

NUWC, BLDG 6 NEWPORT, RI 02841

(REFER TO INSTRUCTIONS)

2. Supplier Name and Address:

3. Date:

4. Date Disposition Required:

5. Material Nomenclature:

6. Work Order #:

W02801

7. Part Number:

8. Quantity:

9. Serial Number:

10. Status of Part: |_| Not Started |_| In-Process |_| Completed

11. Description:

12. Cause Of Nonconformance:

13. Recommended Corrective Action:

14. Recommended Disposition:

15. Technical Justification and Benefit:

Repair Cost:

Replacement Cost:

16. Delivery Impact If Disapproved, Delivery Will Be: If Approved, Delivery Will Be:

The Vendor Accepts Full Responsibility For The Correctness Of Information Affecting The Above Parts

17. Reported By:

SIGNATURE:

PHONE:

VENDOR: DO NOT WRITE BELOW THIS LINE

20. Disposition:

|_| Approved |_| Disapproved |_| Conditionally Approved

Below Space Is For Final Disposition Authorization Use Only:

21. DISPOSITION RESULTS

RFD # |_|YES |_| NO

NAVSEA APPROVAL REQUIRED |_|YES |_| NO

RPR # |_|YES |_| NO

ISEA/TDA APPROVAL REQ’D |_|YES |_| NO

MINOR |_|YES |_| NO

MAJOR |_|YES |_| NO

COST IMPACT |_|YES |_| NO

SCHEDULE IMPACT |_|YES |_| NO

PART NUMBER IMPACT |_|YES |_| NO

Approvals

22. Engineering Date

23. QA Date

24 TAHEF Manager Date

25. ISEA or TDA Date

26. Disposition Sent To Supplier By Purchasing:

Date:

NOTICE TO SUPPLIER: THE DISPOSITION OUTLINED ABOVE IS APPLICABLE TO THE MATERIAL ON THIS VIR ONLY. SHIPPING DOCUMENTS FOR THIS MATERIAL MUST REFERENCE THIS VIR.

NUWCDIVNPT TAHE FACILITYPhone: 401.832.3069 Fax: 401.832.3937 email: ronald.f.hodge@navy.mil

NUWC, BLDG 6 NEWPORT, RI 02841

VENDOR INFORMATION REQUEST FORM INSTRUCTIONS

A PROPERLY APPROVED VENDOR INFORMATION REQUEST (VIR) IS REQUIRED TO RESOLVE TECHNICAL QUESTIONS OR PROBLEMS INVOLVING TOWED ARRAY HANDLING EQUIPMENT FACILITY (TAHEF) WORK ORDERS.

TO FACILITATE THE PREPARATION OF THE FORM, A BRIEF DESCRIPTION APPEARS BELOW INDICATING THE INFORMATION REQUIRED TO BE ENTERED IN THE APPROPRIATE BLOCK. IF MULTIPLE PAGES ARE REQUIRED, LINK ADDITIONAL PAGES BY BLOCK NUMBER TO THE FIRST PAGE.

BLOCK NO. ENTRY (BLOCKS 2-17 TO BE FILLED IN BY THE VENDOR) (BLOCKS 1, 18-26 TO BE FILLED IN BY THE TAHEF)

1. REFER TO THIS NUMBER (PROVIDED BY THE TAHEF) ON ANY INQUIRY. RECORD THIS NUMBER ON THE PACKING LIST PRIOR TO SHIPPING.

2. ENTER YOUR FULL MAILING ADDRESS, INCLUDING THE NAME OF ANYONE TO WHOM THE RETURNED VIR SHOULD BE SENT.

3. THE DATE THE ENTRIES ARE BEING MADE.

4. GIVE DATE A REPLY TO THE VIR IS REQUIRED BY IN ORDER TO AVOID DELAY OF DELIVERY.

5. A GENERAL DESCRIPTION OF THE PART NAME THAT APPEARS ON THE PURCHASE ORDER.

6. WORK ORDER #

7. PART NUMBER

8. QUANTITY OF PIECES AFFECTED BY VIR (NOT QUANTITY ORDERED).

9. SERIAL NUMBER OF PIECE AFFECTED, WHERE APPLICABLE.

10. CHECK APPROPRIATE PART STATUS BLOCK.

11. DESCRIBE THE SPECIFIC PROBLEM/QUESTION/PROPOSED CHANGE, OR NONCONFORMANCE IN DETAIL

· INDICATE WHAT, IF ANYTHING, HAS BEEN VIOLATED

· WHEN PROPOSING A MATERIAL SUBSTITUTION, INCLUDE A FULL DESCRIPTION OF THE SUBSTITUTE MATERIAL (I.E.: ALLOY, CLASS, CONDITION OR TEMPER, SPECIFICATION, ETC.). ATTACH A COPY OF THE TEST REPORT FOR THE MATERIAL IF AVAILABLE OR WITH THE SHIPMENT OF THE COMPLETED HARDWARE.

· WHEN REPORTING A NONCONFORMANCE INVOLVING THE HEAT TREATMENT OF MATERIAL, A COPY OF THE APPLICABLE HEAT TREATMENT PROCEDURE USED SHOULD BE ATTACHED.

· WHEN REPORTING CHEMICAL AND MECHANICAL NONCONFORMANCE, ATTACH A COPY OF THE TEST REPORT APPLICABLE LISTING BOTH CHEMICAL AND MECHANICAL TEST RESULTS OF THE MATERIAL.

· USE A CONTINUATION OR SKETCH SHEET IF THIS SPACE IS INADEQUATE TO SHOW A SKETCH OR TO FULLY DESCRIBE THE PROBLEM.

12. INCLUDE THE CAUSE OF THE NONCONFORMANCE

13. INDICATE THE RECOMMENDED CORRECTIVE ACTION

14. INDICATE THE RECOMMENDED DISPOSITION

15. INCLUDE THE TECHNICAL JUSTIFICATION FOR ACCEPTING PERMANENT NONCONFORMANCE

16. BY INDICATING THE EFFECT OF THE DEVIATION ON THE FORM, FIT OR FUNCTION OF THE MATERIAL, PART OR COMPONENT. IF UNABLE TO PROVIDE TECHNICAL JUSTIFICATION, SO STATE. ALSO PROVIDE RATIONALE FOR PERCEIVED BENEFIT TO PURCHASER. FOR OUTSIDE SERVICES INCLUDE REPAIR VS REPLACEMENT COST.

17. INDICATE THE DELIVERY IMPACT IF ACCEPTANCE OF THE REQUEST IS NOT GRANTED.

18. GIVE NAME OF PERSON TO CONTACT IN CASE OF ANY QUESTIONS REGARDING VIR.

19. FAX VIR TO (401) 832-3937, POINT OF CONTACT PHONE NUMBER IS (401) 832-3069.

20. ENTER DATE VIR RECEIVED FROM VENDOR.

21. ENGINEERING, QA, AND MANAGEMENT ENTER REQUIRED INFORMATION.

22. ENGINEERING, QA, AND MANAGEMENT MARK EACH BLOCK AS APPLICABLE.

23. 22– 25. APPROVALS AS REQUIRED.

24. 26. PURCHASING: SIGN AND DATE WHEN COMPLETED VIR IS SENT TO SUPPLIER.

Revision Date 10/11/19