Form Sf 368 - Product Quality Deficiency Report (Pqdr)
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1PRODUCT QUALITY DEFICIENCY REPORT (PQDR)
REPORT CONTROL
CATEGORY
I
II
DATE
NUMBER (RCN)
1a. FROM (Original Office Mailing Address - include DoDAAC)
1b. ORIGINATOR NAME, PHONE NUMBER & E-MAIL ADDRESS
2a. TO (PQDR Screening Point)
2b. SCREENING POINT NAME, TELEPHONE NUMBER & E-MAIL ADDRESS
3. DESCRIPTION OF DEFICIENCY (Describe in detail what is wrong, circumstances prior to the difficulty, probable cause, any action taken, and
4. DATE DEFICIENCY
recommendations. Attach copy of supporting documents. Continue on separate sheet if necessary. Ensure that the description answers the questions listed
WAS DISCOVERED
in the instructions on the back of this form.)
6. DEFICIENT ITEM NOMENCLATURE
7. OPERATING TIME AT FAILURE
5. DEFICIENT ITEM NATIONAL STOCK
Initial
NUMBER (NSN)
Hours:
Days:
Rounds:
Cycles:
Miles:
Other:
8. DEFICIENT ITEM PART NUMBER
9a. MANUFACTURER'S CAGE CODE
9b. MANUFACTURER / CITY / STATE
10. QUANTITY
11. SERIAL, LOT, OR BATCH NUMBER
12a. ITEM
12b. DATE MANUFACTURED,
12c. LAST REPAIR FACILITY
REPAIRED, OR OVERHAULED
a. RECEIVED:
CAGE:
New
DODAAC:
SERIAL #:
b. INSPECTED:
REPAIR DEPOT / CITY / STATE
Manufactured:
Repaired
Unknown
LOT #:
c. DEFICIENT:
Repaired:
Overhauled
d. IN STOCK:
N/A
Overhauled:
Unknown
BATCH #:
13a. CONTRACT NUMBER
13b. REQUISITION / DOCUMENT NUMBER
13c. PURCHASE ORDER NUMBER
14. GOVERNMENT FURNISHED MATERIAL
15a. ITEM UNDER WARRANTY
15b. WARRANTY EXPIRATION DATE
16. END ITEM EIC/WUC/TAMCN
YES
NO
UNKNOWN
YES
NO
UNKNOWN
17. NEXT HIGHER ASSEMBLY
a. NSN
b. NOMENCLATURE
c. PART NUMBER
d. SERIAL NUMBER
18. END ITEM
a. NSN
b. NOMENCLATURE
c. TYPE/MODEL
d. SERIAL NUMBER
19. CURRENT DISPOSITION OF DEFICIENT ITEM (the Exhibit)
(Select only one value)
HOLDING EXHIBIT
DISPOSED OF / DESTROYED
REPAIRED
OTHER (Explain in Block 3)
20. LOCATION OF DEFICIENT MATERIAL (e.g. Base, Camp, Station)
21. ACTION REQUESTED (Select only one value)
REPLACEMENT
REPAIR
CREDIT
OTHER (Explain in Block 3)
368-102
STANDARD FORM 368 (REV. 5/2011)
GENERAL SERVICES ADMINISTRATION
(FPMR 101 - 26.8)
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