首件样品检验报告
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Dimensions nominal
实测结果(供应商)
Actual Results (Supplier)
AT
实测结果(客户)
Actual Results (Buyer)
AT
结论
Decision
A
B
C
D
1
Surface structure皮纹
2
Color颜色 P3@pos.
△E≤3（D65）
DL*（~B0）
样品数量
Quantity of samples
备注
Remark
首件样品检验原因
Reason for initial sample inspection
新供应商new supplier
新零件new part
规格更改changed specifications
产品加工过程更改changed production process
Write supplier name in English or in Chinese Pinyi
供应商
Supplier
报告编号.
Report No.
参考
Reference
采购人员/BUYER
购货商(客户)
BUYER (Customer)
报告编号.
Report No.
参考
Reference
共张，第张
检验结果/ Test result
检验结论见表一/ Result report see page 1
供应商
Supplier
报告编号.
Report No.
参考
Reference
供应商/ SUPPLIER
填写“公司的英文或中文名及相应中文拼音”
Write supplier name in English or in Chinese Pinyi
Write “part Code”“cccoe“code““compannanamename
零件名称
DesignationWrite “partname”
图纸版本
Index:
零件编号.
Part No.
零件名称
Designation
图纸版本
Index
签发日期
Date issued填写报告日期
Write report date
签名/ Signature张三.
备注(供应商)/Remarks (Supplier):
填写：
1．此样品第几次送样；
2. 所附加其它报告（如材质报告），或其它报告见哪份FSR
Write: 1. Sample delivery times; 2. Attached report name
备注/Remarks (CEN):
修改日期.
Modification No.
进料日期
Incoming date
填表日期
Date of Issue
外观批准报告Appearance Approval Report(AAR)
首件样品检验报告Initial Sample Inspection Report
供应商/ SUPPLIER
填写“公司的英文或中文名及相应中文拼音”
供应商/SUPPLIER
购货商(客户)/Purchaser(Customer)
编号Pos.
规格要求
Dimensions nominal
实测结果(供应商)
Actual Results (Supplier)
AT
实测结果(客户)
Actual Results (Buyer)
AT
结论
Decision
A
B
C
D
1
Da*（+Red / green-）
Db*（+Yel / blue-）
3
sharp edges, esp in the access area 锐边，尤其在接触区P6
4
Incidence points (sink mark) 缩痕评估 P7
Visible area A: front and top 能见区A：前面、上面
1.Initial samples must be taken from 1~8 hours production with a minimum 300 consecutive parts, unless otherwise specified by CEN quality rep. .除非斯易安品质代表特别同意，首件样品必须1~8小时的量产，且规定的生产数量至少为300件连续生产的零件。
报告编号
Report No.填写内部报告编号Write reportNo
参考
Reference
Write last FSR No
签发日期
Date issued
报告编号.
Repor具编号填写模具编号
Tool No.write“mould No”
模腔数目填写模腔数
No. of cavitieswrite“cavity NO”
Sheetof Sheet
零件编号/名称
Part No./Designation填写“图号”和“零件名称”write code and part name
零件编号/名称
Part No./Designation
供应商/SUPPLIER
购货商(客户)/Purchaser(Customer)
编号Pos.
规格要求Kan
Initial Sample Inspection Report
接收人Recipient
部门Dept:填写“相关接收样品的部门”
write“recipient department name“
姓名Name:填写“ 接收样品的人员姓名”
Write“recipient name“
外观批准报告（由品质部批准）
第1 张 共张
Sheet 1 of sheet.
供应商编号SupplierID ：
名称Name：填写“公司的英文或中文名及相应中文拼音”
Write “company name”or in Chinese pinyi
地址Address填写“公司地址”
Write“company adress“
首件样品检验报告
新的制造地new manufacturing location
产品长期停产>1年extended interruption of production>1year
由供应商和客户共同核准的首件样品检验的规范，存放在以下文档中
The specifications jointly approved by the Buyer and Supplier forthe initial sample inspection are contained in the following documents:
重量/Weight
备注(供应商)/Remarks (Supplier):
备注(客户)/Remarks (Customer):
1.For K andA qualitydimensions, quality rep reserves the right to require initial processcapability. The process with index (Cpk or Ppk )< is not accepted for FSR release.对于K类和A类尺寸，品质代表有权要求供方保证初期过程能力,指数值小于的过程不符合FSR接受准则。
违禁物质声明/Declaration of substances:
是/yes否/no
REACH禁用物质清单REACH candidate list(SVHC):
noSVHC substances in aconcentration>%,
reference参见:
是/yes否/no* ------->*
Appearance Approval Report (AARby quality)
尺寸检验报告Dimension Report
材料检验报告
Material Report
性能检验报告
Function Report
供应商/ SUPPLIER
购货商(客户)/ BUYER (Customer)
零件编号.
Part No.填写“图号”
结论/Decision: 1=接收approved;2.一定条件下接收approved with concession;3拒收,交新样品rejected new samples required;4.无要求not requested;5.处理中in process.
1
2
3
4
5
尺寸Dimensions
Modification No.
进料日期
Incoming date
填表日期
Date of Issue
首件样品检验报告
尺寸检验报告
Dimension Report
材料检验报告
Material Report
性能检验报告
Funktion Report
Initial Sample Inspection Report
购货商(客户)
BUYER (Customer)
报告编号.
Report No.
参考
Reference
共张，第张
Sheetof Sheet
零件编号/名称
Part No./Designation填写“图号”和“零件名称”write code and part name
零件编号/名称
Part No./Designation
条件Conditions：
我们供应商在此声明,
1.所提交的样品是完全采用正常生产的原材料，按照正常批量生产的方法生产的;
2.样品检验准确结果如报告（偏差见附表）,
3.首件样品批准并不免除供应商按适用的图纸和规格交付产品的责任.
We hereby certify,
1.That samples submitted are completely made with regular production resources followingregular series production methods.
检验结果见附表
实际尺寸见样品检验单
不合格的在“AT”栏中注明
For inspection results, refer to attached sheets:
The actual measurements are given in order of the samples.
Non-conforming specifications are indicated in the column "AT".
DateAccountable Signature
正楷填写 责任人签字
Plain WritingAccountable Signature
分发：品质/采购/物流/研发/工艺工程师Distribution: QA/Purchasing/R&D/Logistic/Process Engineering
修改日期.
日期责任人签名
DateAccountable Signature
日期责任人签名
DateAccountable Signature
注释:
A =必须修改/CorrectionC =考虑修改图纸偏差/Deviations will be consideredin the drawing
B =允许使用数量/Limited use allowed for单位/UnitsD =可接收的偏差/Acceptable deviation
填写“图纸尺寸(必须包括公差)或其它要求“
填写“实测尺寸或其它要求的结果”
Write“dimension require pluge tolerance or other requirement”
Write“acutal measured dimension or other requirement result”
材质报告Materialanalyse
性能测试Test
RoHS
REACH
放行Release
重新送样new sample needed是yes
日期Date:部门Dept：.
名字/电话号码(如有疑问以便联系)
Name / Telephone No. (in case of queries)
日期：填写日期date责任人签名：签字signature
Visible area B: on the sides能见区B：侧面
2.The correct inspections of the samples and their listing in this report (deviations are shownseparately).
3.That a sample approval does not relieve the supplier of hisresponsibility to deliver materialaccordingto the applicable drawings and specifications.
实测结果(供应商)
Actual Results (Supplier)
AT
实测结果(客户)
Actual Results (Buyer)
AT
结论
Decision
A
B
C
D
1
Surface structure皮纹
2
Color颜色 P3@pos.
△E≤3（D65）
DL*（~B0）
样品数量
Quantity of samples
备注
Remark
首件样品检验原因
Reason for initial sample inspection
新供应商new supplier
新零件new part
规格更改changed specifications
产品加工过程更改changed production process
Write supplier name in English or in Chinese Pinyi
供应商
Supplier
报告编号.
Report No.
参考
Reference
采购人员/BUYER
购货商(客户)
BUYER (Customer)
报告编号.
Report No.
参考
Reference
共张，第张
检验结果/ Test result
检验结论见表一/ Result report see page 1
供应商
Supplier
报告编号.
Report No.
参考
Reference
供应商/ SUPPLIER
填写“公司的英文或中文名及相应中文拼音”
Write supplier name in English or in Chinese Pinyi
Write “part Code”“cccoe“code““compannanamename
零件名称
DesignationWrite “partname”
图纸版本
Index:
零件编号.
Part No.
零件名称
Designation
图纸版本
Index
签发日期
Date issued填写报告日期
Write report date
签名/ Signature张三.
备注(供应商)/Remarks (Supplier):
填写：
1．此样品第几次送样；
2. 所附加其它报告（如材质报告），或其它报告见哪份FSR
Write: 1. Sample delivery times; 2. Attached report name
备注/Remarks (CEN):
修改日期.
Modification No.
进料日期
Incoming date
填表日期
Date of Issue
外观批准报告Appearance Approval Report(AAR)
首件样品检验报告Initial Sample Inspection Report
供应商/ SUPPLIER
填写“公司的英文或中文名及相应中文拼音”
供应商/SUPPLIER
购货商(客户)/Purchaser(Customer)
编号Pos.
规格要求
Dimensions nominal
实测结果(供应商)
Actual Results (Supplier)
AT
实测结果(客户)
Actual Results (Buyer)
AT
结论
Decision
A
B
C
D
1
Da*（+Red / green-）
Db*（+Yel / blue-）
3
sharp edges, esp in the access area 锐边，尤其在接触区P6
4
Incidence points (sink mark) 缩痕评估 P7
Visible area A: front and top 能见区A：前面、上面
1.Initial samples must be taken from 1~8 hours production with a minimum 300 consecutive parts, unless otherwise specified by CEN quality rep. .除非斯易安品质代表特别同意，首件样品必须1~8小时的量产，且规定的生产数量至少为300件连续生产的零件。
报告编号
Report No.填写内部报告编号Write reportNo
参考
Reference
Write last FSR No
签发日期
Date issued
报告编号.
Repor具编号填写模具编号
Tool No.write“mould No”
模腔数目填写模腔数
No. of cavitieswrite“cavity NO”
Sheetof Sheet
零件编号/名称
Part No./Designation填写“图号”和“零件名称”write code and part name
零件编号/名称
Part No./Designation
供应商/SUPPLIER
购货商(客户)/Purchaser(Customer)
编号Pos.
规格要求Kan
Initial Sample Inspection Report
接收人Recipient
部门Dept:填写“相关接收样品的部门”
write“recipient department name“
姓名Name:填写“ 接收样品的人员姓名”
Write“recipient name“
外观批准报告（由品质部批准）
第1 张 共张
Sheet 1 of sheet.
供应商编号SupplierID ：
名称Name：填写“公司的英文或中文名及相应中文拼音”
Write “company name”or in Chinese pinyi
地址Address填写“公司地址”
Write“company adress“
首件样品检验报告
新的制造地new manufacturing location
产品长期停产>1年extended interruption of production>1year
由供应商和客户共同核准的首件样品检验的规范，存放在以下文档中
The specifications jointly approved by the Buyer and Supplier forthe initial sample inspection are contained in the following documents:
重量/Weight
备注(供应商)/Remarks (Supplier):
备注(客户)/Remarks (Customer):
1.For K andA qualitydimensions, quality rep reserves the right to require initial processcapability. The process with index (Cpk or Ppk )< is not accepted for FSR release.对于K类和A类尺寸，品质代表有权要求供方保证初期过程能力,指数值小于的过程不符合FSR接受准则。
违禁物质声明/Declaration of substances:
是/yes否/no
REACH禁用物质清单REACH candidate list(SVHC):
noSVHC substances in aconcentration>%,
reference参见:
是/yes否/no* ------->*
Appearance Approval Report (AARby quality)
尺寸检验报告Dimension Report
材料检验报告
Material Report
性能检验报告
Function Report
供应商/ SUPPLIER
购货商(客户)/ BUYER (Customer)
零件编号.
Part No.填写“图号”
结论/Decision: 1=接收approved;2.一定条件下接收approved with concession;3拒收,交新样品rejected new samples required;4.无要求not requested;5.处理中in process.
1
2
3
4
5
尺寸Dimensions
Modification No.
进料日期
Incoming date
填表日期
Date of Issue
首件样品检验报告
尺寸检验报告
Dimension Report
材料检验报告
Material Report
性能检验报告
Funktion Report
Initial Sample Inspection Report
购货商(客户)
BUYER (Customer)
报告编号.
Report No.
参考
Reference
共张，第张
Sheetof Sheet
零件编号/名称
Part No./Designation填写“图号”和“零件名称”write code and part name
零件编号/名称
Part No./Designation
条件Conditions：
我们供应商在此声明,
1.所提交的样品是完全采用正常生产的原材料，按照正常批量生产的方法生产的;
2.样品检验准确结果如报告（偏差见附表）,
3.首件样品批准并不免除供应商按适用的图纸和规格交付产品的责任.
We hereby certify,
1.That samples submitted are completely made with regular production resources followingregular series production methods.
检验结果见附表
实际尺寸见样品检验单
不合格的在“AT”栏中注明
For inspection results, refer to attached sheets:
The actual measurements are given in order of the samples.
Non-conforming specifications are indicated in the column "AT".
DateAccountable Signature
正楷填写 责任人签字
Plain WritingAccountable Signature
分发：品质/采购/物流/研发/工艺工程师Distribution: QA/Purchasing/R&D/Logistic/Process Engineering
修改日期.
日期责任人签名
DateAccountable Signature
日期责任人签名
DateAccountable Signature
注释:
A =必须修改/CorrectionC =考虑修改图纸偏差/Deviations will be consideredin the drawing
B =允许使用数量/Limited use allowed for单位/UnitsD =可接收的偏差/Acceptable deviation
填写“图纸尺寸(必须包括公差)或其它要求“
填写“实测尺寸或其它要求的结果”
Write“dimension require pluge tolerance or other requirement”
Write“acutal measured dimension or other requirement result”
材质报告Materialanalyse
性能测试Test
RoHS
REACH
放行Release
重新送样new sample needed是yes
日期Date:部门Dept：.
名字/电话号码(如有疑问以便联系)
Name / Telephone No. (in case of queries)
日期：填写日期date责任人签名：签字signature
Visible area B: on the sides能见区B：侧面
2.The correct inspections of the samples and their listing in this report (deviations are shownseparately).
3.That a sample approval does not relieve the supplier of hisresponsibility to deliver materialaccordingto the applicable drawings and specifications.