SUPPLIER SUBMITTAL REQUEST (SSR) SSR#: SSR TYPE (CHECK BOX) SUBMITTED BY SUPPLIER DATE SUBMITTED: (Name / Address): NON-CONFORMANCE RESPONSE NEED DATE: INFORMATION REQUEST CHANGE REQUEST DATE LOGGED IN BY AR: PROCESS CONTROL PLAN SUBMISSION P.O. NUMBER: CHANGE REQUEST SPECIAL PROCESS APPROVAL P. O. LINE ITEM #: PART DESCRIPTION: SUBMISSION CHANGE REQUEST PART NUMBER / DRAWING, NONDESTRUCTIVE TESTING REV.: LOT NUMBER / SERIAL FIRST ARTICLE NUMBER: PLAN PROGRAM: COMPLETED REPORT DELTA REPORT QUANTITY: SUPPLIER EMAIL: EFFECTIVITY / IMPACT TO AEROJET AR BUYER / EMAIL: ROCKETDYNE: DATE: HAS A SSR BEEN PROCESSED PREVIOUSLY FOR THIS ISSUE? Yes No LIST SSR NOs: HAS MATERIAL BEEN DELIVERED TO AEROJET ROCKETDYNE THAT IS DIRECTLY AFFECTED BY THIS SSR? Yes No If yes, please provide a brief explanation. SSR DESCRIPTION: CAUSE / SOURCE OF REQUIREMENT(S): SUPPLIER CONTAINMENT ACTION TAKEN CORRECTIVE ACTION / EFFECTIVITY OR RECOMMENDED ACTION SUPPLIER TITLE: DATE: REPRESENTATIVE’S SIGNATURE: PHONE: SSR NO. PAGE 2 OF
SUPPLIER SUBMITTAL REQUEST (SSR) SSR#: SSR TYPE (CHECK BOX) NON-CONFORMANCE INFORMATION REQUEST CHANGE REQUEST PROCESS CONTROL PLAN SUBMISSION CHANGE REQUEST SPECIAL PROCESS APPROVAL SUBMISSION CHANGE REQUEST NONDESTRUCTIVE TESTING FIRST ARTICLE PLAN COMPLETED REPORT DELTA REPORT EFFECTIVITY / IMPACT TO AEROJET ROCKETDYNE: DATE: SUBMITTED BY SUPPLIER (Name / Address): DATE SUBMITTED: RESPONSE NEED DATE: DATE LOGGED IN BY AR: P.O. NUMBER: P. O. LINE ITEM #: PART DESCRIPTION: PART NUMBER / DRAWING, REV.: LOT NUMBER / SERIAL NUMBER: PROGRAM: QUANTITY: SUPPLIER EMAIL: AR BUYER / EMAIL: HAS A SSR BEEN PROCESSED PREVIOUSLY FOR THIS ISSUE? Yes No LIST SSR NOs: HAS MATERIAL BEEN DELIVERED TO AEROJET ROCKETDYNE THAT IS DIRECTLY AFFECTED BY THIS SSR? Yes No If yes, please provide a brief explanation. SSR DESCRIPTION: CAUSE / SOURCE OF REQUIREMENT(S): SUPPLIER CONTAINMENT ACTION TAKEN CORRECTIVE ACTION / EFFECTIVITY OR RECOMMENDED ACTION SUPPLIER REPRESENTATIVE’S SIGNATURE: TITLE: DATE: PHONE: SSR NO. PAGE 2 OF