GM_1927-54_CS1_CS2_Exit_Checksheet

InstructionsHereCONTROLLED SHIPPING LEVEL 1Exit Package Checklist Orig. Date:Rev. Date:GM Initiator: GM Initiating Plant: Provider: PQE:Supplier Name:Supplier DUNS Number:Plant Location Country:Part name:Part number:PRR Number:Problem description:Instructions : 1) GM initiator is to review \"yes\" & \"no\" items indicated below. 2) For desired items, GM initiator is to change check marks to \"yes\". 3) For items not required, GM initiator is to change check mark to \"no\" (for default items) OR leave check mark as \"no\". 4) Once complete, GM initiator should promptly send to the PQE. 5) Unless revised, the supplier's exit package will be based upon this document.Default Items1) Email requesting exit from CS1 (if marked \"no\communication)2) Copy of completed CS1 Master DOT Action Plan3) Documentation of completion of any required workshopsYesXXXNo CommentsCS1 Specific Items4) Copy of passed CS1 Assessment5) Copy of passed CS1 Assessment Matrix6) Copy of CS1 inspection I-chart showing required number of defect-free days achievedYesNoXXX CommentsOther Items7) Updated PFMEA, Process Control Plan (including GP-12, ifapplicable)8) Updated operator work instructions9) Updated Process Flow DiagramYesNoXXX Comments10) Training recordsX11) Copies of Drill Deep & Wide response (other than those sentoriginally w/ PRR response)12) Copies of Master DOT action plans from any required workshops13) Corrective action report (other than PRR response)XXX 14) Evidence of error proofing/error detection, if applicableX15) PPAP documentation, if applicable)X16) Statistical data, if applicableX17) Evidence of layered audits related to the corrective actionX18) Documentation of review plan or approval of TS16949 registrarXOther GM Initiator Specific Items (please list)GM 1927-54 CS1_Checksheet with package 6-18-091 of 3247660885.xls

InstructionsHereCS1 EXIT WORKSHEETSUPPLIER CORRECTIVE ACTION VERIFICATION(Note – Items in red are to have appropriate information inserted by the letter writer.- TURN OFF RED & REMOVE THIS NOTE BEFORE DISTRIBUTING!) (single click on red text & type)Initiating Plant: type plant Initiating SQE: type SQE name Date of CS1 Entry Letter: type dateDate of Exit Request:Supplier Representative Requesting Exit:Part Number(List all affected part numbers)Part Name(List all affected part names)Non-conformance(s)(List defects as noted on the exit request and entry letter)PRR Number(List all current and recent PRR’s related to the non-conformity)Plants Affected (Note: Please notify the GM person that issued the CS1 if you have distributionchanges from original letter).Supplier Location (City, State, etc.)Supplier Information:Supplier Mfg Location Duns #Supplier Name Supplier Contact at Review Provider Contact at Review Phone Phone EmailEmailAcknowledgment Required By: (Please complete table below with “Yes” or “No” and other information when your role is indicated at the left of the table)PQEXXSQEXXXVerification Information (Check Off as Appropriate)Pass CS1 Assessment20 days without Defect after Corrective Action in place (5days for error proofing solution)GM Manager Approval (if required)Initiating SQE Approval Original duns must be color coded Green for correctiveaction on all Read Across items for CS1 issue. Other duns location with similar process must be Yellow(minimum) on CS1 issue. Other PRR's within 8-week window must be Green (dunson CS1) or Yellow (other locations) for containment. Otherread across items (i.e. predict corrective action) can be Redif closure dates are identified.Other items required for exit as per entry letter, kickoffmeeting, & CS1 Process are present in exit packagesubmission. Examples: Updated PFMEA, PCP, Work Instructions, etc. Training Records Containment Data Completed Master Dot & Assessment Matrix Documented acceptance or review plan by ISO/TSregistrar.Provider QE RecommendationOther (List Name or Title)YESNO NameDate Comments XX XX XGM 1927-54 CS1_Checksheet with package 6-18-092 of 3247660885.xls

Recommended for Removal from Controlled Shipping:(check only one option below, to be completed by SQE)** Please remember that CS1 exit requests from suppliers MUST be responded to within 72 hours of receipt.Name: Date:Removal from the CS1 for: (List specific PN/s, Part Name/s and issues to be Removed from CS1)Cancel all CS requirements. All CS records specific to this issue are to be deleted from GQTS.Exit denied.If “Exit Denied” is checked, attach CS1 Exit Request Denial Form.Additional PagesGM 1927-54 CS1_Checksheet with package 6-18-093 of 3247660885.xls