Standard Form 368 - Product Quality Deficiency Report Page 2

Download a blank fillable Standard Form 368 - Product Quality Deficiency Report in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Standard Form 368 - Product Quality Deficiency Report with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

INSTRUCTIONS
1a. FROM (Originating Office Mailing Address) – Complete name of
activity (no acronyms when sending deficiency report across
13. OPERATING TIME AT FAILURE – Time item had been in
component lines), activity address code (ACC) mailing address
operation since new, overhauled, or repaired when the deficiency
including zip code of the activity originating the report.
was discovered, citing the appropriate performance element (miles,
cycles, hours, etc.).
1b. ORIGINATOR NAME, PHONE NUMBER & E-MAIL ADDRESS
– Provide name, telephone number (including all available telephone
numbers; FTS; Autovon, and commercial) and email address of an
15a. QUANTITY RECEIVED – Enter the total number of items or
individual who can serve as a contact for questions regarding the
parts received.
report and/or to request exhibits or samples.
15b. QUANTITY INSPECTED – Enter the total number of items
1c. DATE SUBMITTED – Enter date report was signed and
inspected.
forwarded to the screening or action point.
15c. QUANTITY DEFICIENT – Enter the quantity found deficient of
2a. TO (PQDR Screening Point) – The originating point will
those inspected.
complete name of the screening point activity (no acronyms when
deficiency report will be including zip code of the screening point
15d. QUANTITY IN STOCK – Enter the quantity of material from the
where the report needs to be sent by the originator’s activity. For
same manufacturer remaining in stock.
those activities that do not have screening points, leave blank.
17. DEFECTIVE ITEM UNIT COST – Dollar value of the deficient
2b. NAME, TELEPHONE NUMBER AND E-MAIL ADDRESS –
item when known. Not applicable on reporting vehicles to GSA.
Nothing follows.
18. ESTIMATED REPAIR COST – Unit cost times number of units
2c. DATE – Enter the date the person finished processing the report
for replacement or estimated repair costs (including overhead) times
at the screening point.
number of units for correcting all the deficient items reported when it
can readily be determined. Not applicable on reporting vehicles to
3.
REPORT CONTROL NUMBER – Number assigned to report
GSA.
when a numbering system is used.
Those activities which are
reporting quality deficiencies across component lines and are to
19a. ITEM UNNDER WARRANTY – Check if item is known to be
comply with the DLA Regulation 4155.24 should reference the report
covered by contractor warranty. If yes, provide expiration date.
control number as prescribed in the regulation.
19b. WARRANTY EXPIRATION DATE – Provide the date the
7a. MANUFACTURER OR REPAIR DEPOT / CITY / STATE –
warranty is set to expire.
Name of the manufacturer, the maintenance contractor, or
Government activity which last repaired or overhauled the deficient
20. END ITEM TAM – Nothing follows.
item.
For motor vehicles or components thereof, enter name of
manufacturer of the vehicle or component, as appropriate.
21a. ACTION REQUESTED (Select only one value) – A check in the
appropriate block to indicate the action taken or requested.
7b. MANUFACTURER’S CAGE CODE – Code of the manufacturer
Reporting activities are reminded that the packaging, packing and
as listed in Cataloging Handbook H4.1 (Name to code), Federal
shipping containers are to be held along with the exhibits to facilitate
Supply Code for manufacturer (United States and Canada).
investigation. When none of the items indicate the actions taken or
requested, check “OTHER” and identify the nature of the action taken
7c. SHIPPING / CITY / STATE – When the shipper of an item is
or requested in item 22.
different from the manufacturer, also include the shipper’s or
supplier’s name.
21b. CURRENT DISPOSITION OF DEFECTIVE ITEM (the Exhibit)
(Select only one value) – A check in the appropriate block to indicate
9.
SERIAL / LOT / BATCH NUMBER – Manufacturer’s serial, lot,
the action taken or requested. When an exhibit or sample is being
or batch number of deficient items as applicable.
held, indicate the number of days in the space provided. (An exhibit
or sample shall be held for a minimum of 30 calendar days from date
10a. CONTRACT NUMBER – Enter contract number.
the report is transmitted to the action point.
ACO will instruct
disposition of the item. When none of the items indicate the actions
10b. PURCHASE ORDER NUMBER – Enter purchase order number.
taken or requested, check “OTHER” and identify the nature of the
action taken or requested in item 22.
10c. REQUISITION / DOCUMENT NUMBER – Enter requisition
and/or number.
22. DESCRIPTION OF THE DEFECT (describe in detail what is
wrong, circumstances prior to the difficulty, probable cause, any
10d. GBL NUMBER – Nothing follows.
action taken, recommendations.
Attach copies of supporting
documents. Continue on separate sheet if necessary.) – Nothing
11. ITEM – Check the appropriate block; provide the dates
follows.
manufactured and received in Block 12, if available.
23. LOCATION OF DEFICIENT MATERIAL (e.g. Base, Camp,
12. DATE RECEIVED, MANUFACTURERED, REPAIRED, OR
Station) – Nothing follows.
OVERHAULED – Nothing follows.
STANDARD FORM 368 (REV. 6/2007) BACK

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 2