Deviation Request Form
This form is to be used by Suppliers to request a deviation from the Design Standards (on a specific part
number and lot) and must be completed before shipment.
Please print, fill out, and mail the following form to:
Site Quality Manger at Watts Water Technologies, Inc. or its Divisions.
A. Supplier and Part Information
Watts Part Number:____________________________
Supplier Name: __________________________________
Watts Part Description: __________________________
Supplier Contact: __________________________________
Watts Revision Level: ___________________________
Supplier Email: __________________________________
Watts PO Number: _____________________________
Supplier Phone: __________________________________
Quantity: _____________________________________
Supplier Address: _________________________________
Required Date: ________________________________
Supplier City: __________________________________
Watts Name of Project: __________________________
Supplier State: Zip: ___________________
Today’s Date: _________________________________
B. Deviation Information
Deviation Request is: Process Related: ______ Product Related: ______
1st Time: ______ Material Change: ______
Permanent: ______ Temporary: ______
Current Specification or Process:
Proposed Deviation:
Reason for Deviation/Justification/Corrective Action:
C. Watts Approval/Disapproval
Watts Approval/Disapproval Signed by:
_______ Recommended Name:___________________
_______ Recommended as Noted
_______ Not Recommended Signature:________________
_______ Received Too Late
Date:____________________
D. Disposition
Document Change Required? _____Yes/No_____ If Yes, ECN#___________
Comments:______________________________________________________ Rev. 04/15/2011