Supplier Name Part Number Revision Part Description

Specification & Method Test Description Acceptance Criteria Test Stage Target Requirements Sample Type Sample Level Actual Results Additional Notes

Specification Provide a brief desription Specify test targets and/or ED = Engineering Devel't Testing State required probability Describe the A = Prototype (Handmade) List results in terms Describe or

governing test of each test. pass/not pass criteria. DV = Design Verification or reliability and confidence sample to be B = Prototype (Tooled) of reliability or elaborate on

& test method used Include SC/CC/KPC Symbol e.g. cycles, miles, volts, PV = Production Validation of meeting acceptance tested (see C = Production Tool (Not Process) probability as appropriate sub-phases

(if applicable). List the Customer or minimum value, no CCT = Continued Compliance Testing criteria, e.g. R90 C90, or sample level) D = Production Tool and Process

designated symbol breakage, etc. All must pass.

if applic., e.g. KPC

Test ReportTest Specification Acceptance Test Target Test Timing Est. Sample Timing Sample Pass/ Actual Additional

ID & Test Method Criteria Stage Requirements Responsibility Start Comp. Qty Type Act. Comp. No Level Not Pass Results Notes

I affirm that the samples used for verification testing are representative of our parts, and I authorize the use of the design.

Date

Test Description

Test Plan

Supplier Authorized Signature Title

Verification Report Authorization

DESIGN VERIFICATION PLAN AND REPORT