Doc No: PROD/F/16
4M change Intimation and Inspection Results Rev. No/Date: 00 / NA
Issue Date: 01.04.2023
MACHINE Operation Date Shift& TIME
PART NAME/ MODEL (if any) : Raw material Batch No.:
Current Operator Name : 4M Tag Unique No. (if applicable):
NATURE OF CHANGE ( Please Tick ü ) CHANGE DESCRIPTION ( Please Tick ü )
MAN METHOD Planned Condition Unplanned Condition
MACHINE MATERIAL Abnormal Change
What Happened (Condition) :
What changes
had done on
process:
CHANGE CONTROL RESPONSIBLE PERSON
(Production Sup. / Production head)
Action Required Setup Approval Retroactive Containment Customer Approval
(Tick applicable one as per 4M WI) Inspection
Remarks
CHANGE APPROVAL AUTHORITY
(Quality Head)
For Setup Approval :- Seprate shee to be attached along with this records.
A. Visual Inspection
Check Points Qty Checked OK Qty NG Qty & Reason Name of Inspector Remarks
(As per Ins Std. / Control Plan)
Time of abnormal Incident : Production Rate / Hour
(Based on documentory evidence)
Total time where suspected
part may produced.
Last Inspection time
(Based on documentory evidence) Suspected Qty for Retro Check
B. Dimensional Inspection (As per Inspection std. / Control Plan)
Suspected Lot Size : Sample Size as per Std.:
………………………………..…………NOS …………………………..…NOS
Results Judgement
S.No. Inspection Parameter Specification Instrument (no. of samples as per sampling plan) (OK/NG)
1 2 3 4 5 6 7 8 9
4
RETROACTIVE CHECK
10
11
12
13
14
15
16
17
Comments if any:
Checked By Approved By
A. Visual Inspection
NG Qty &
Check Points Qty Checked OK Qty Reason Name of Inspector Remarks
(As per Ins Std. / Control Plan)
B. Dimensional Inspection (As per Inspection std. / Control Plan)
Suspected Lot Size Sample Size as per Std.
…………………………………....…….NOS ……………………...…….NOS
Results Judgement
(no. of samples as per sampling plan) (OK/NG)
S.No. Inspection Parameter Specification Instrument
1 2 3 4 5 6 7 8 9
7
CONTAINMENT CHECK
10
11
12
13
14
15
16
17
18
19
Comments if any:
Checked By Approved By
Doc No: PROD/F/16
4M change Intimation and Inspection Results Rev. No/Date: 00 / NA
Issue Date: 01.04.2023
MACHINE Operation Date Shift
PART NAME/ MODEL (if any) : Raw material Batch No.:
Current Operator Name : 4M Tag Unique No. (if applicable):
NATURE OF CHANGE ( Please Tick ü ) CHANGE DESCRIPTION ( Please Tick ü )
MAN METHOD Planned Condition Unplanned Condition
MACHINE MATERIAL Abnormal Change
What Happened (Condition) :
What changes had done on
process:
CHANGE CONTROL RESPONSIBLE PERSON
(Production Sup. / Production head)
Action Required Retroactive
Setup Approval Containment Customer Approval
(Tick applicable one as per 4M WI) Inspection
Remarks
CHANGE APPROVAL AUTHORITY
(Quality Head)
For Setup Approval :- Seprate shee to be attached along with this records.
A. Visual Inspection
Check Points Qty Checked OK Qty NG Qty & Name of Inspector Remarks
(As per Ins Std. / Control Plan) Reason
B. Dimensional Inspection (As per Inspection std. / Control Plan)
Suspected Lot Size Sample Size as per Std.
S.No. Inspection Parameter Specification Instrument Results Judgement
(no. of samples as per sampling plan) (OK/NG)
4
CONTAINMENT CHECK
10
11
12
13
14
Comments if any:
Checked By Approved By
