Supplier Qualification

Confidentiality Maintained by Electro Scientific Industries

Supplier:	Supplier Code:
Supplier Address:	Phone:

Assessment Date:
Assessment Type: Self-Evaluation Initial Evaluation Periodic Follow-up	Status: Not Qualified Qualified Preferred
Assessment Score:
Corrective Action Required: Yes No
Corrective action to be completed by (date):
On-site follow-up for verification scheduled (date):
Assessment conducted by:
Supplier representative:
Other Supplier Representatives
Senior Official:	Title:
Engineering:	Title:
Manufacturing:	Title:
Quality Assurance:	Title:
Sales/Marketing:	Title:
Other:	Title:
Total employees at plant:	Mfg: QA/QC:
Plant Capacity (sq ft):	Union (if applicable):
Other plant locations and capacities:
Manufacturing capabilities and special processes:
Latest advanced developments: