SUPPLIER CHECKLIST FOR VIR (WAIVERS)
(Supplement for Form DAC 26-888)

Waiver: A written authorization to accept a configuration item or other designated item which, during production or after having been submitted for inspection, is found to depart from specified requirements, but considered, nevertheless, suitable for use "as is" or after repair by an approved method.

1. VENDOR NAME, ADDRESS, TELEPHONE NUMBER

2. PART NUMBER PER PURCHASE ORDER

3. PART NAME PER PURCHASE ORDER

4. DETAIL PART NUMBER & CHANGE LETTER IF DAC DRAWING (*)

5. DETAIL PART NAME (*)

6. SUPPLIER DRAWING/BLUEPRINT (*)

7. PURCHASE ORDER NUMBERS

8. QUANTITY SUBMITTED AND AFFECTED

9. STATE DRAWING/SPEC REQUIREMENT LOCATION (*)

10. DESCRIPTION OF DISCREPANCY (IS)--SKETCH, ZONE, G/N, ETC. (*)

11. IDENTIFICATION NUMBER(S) FOR PART/MATERIAL, SERIAL, LOT, BATCH, HEAT OR ROLL (*)

12. ADDITIONAL INFORMATION TO SUPPORT VIR

13. NOTE IF DAC FURNISHED MATERIAL OR TOOLING (*)

14. ROOT CAUSE OF DISCREPANCY

15. CORRECTIVE ACTION STATEMENT AND EFFECTIVITY

Note: (*) = if applicable