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Respectfully Submitted by Pro QC International Limited Taiwan Branch (HK) PSI Form - Rev6 - 2 Dec 2010

PassedFailedOn HoldFailed / On HoldMis-Inspection

CLIENTATTENTION 1 OFTITLE

FAX NUMBER

CC TO

TITLE

FAX NUMBER

TYPE OF XSERVICE

REFERENCE Page 2~5 Page Page Page PagePRODUCT DESCRIPTION

PART NUMBER

COLOR / FINISH

SPEC / REVP.O. NUMBER

UNIT OF MEASURE

Booking / Cartons Qty 5,136 2,568Actual / Cartons Qty 5,136 2,568INSPECTION RESULT

SEE NOTE NUMBER

REFERENCE Page Page Page Page PagePRODUCT DESCRIPTION

PART NUMBERCOLOR / FINISH

SPEC / REVP.O. NUMBER

UNIT OF MEASURE

Booking / Cartons QtyActual / Cartons QtyINSPECTION RESULT

SEE NOTE NUMBER

Number12

Inspector / Reviewer QC Engineer

XXX00036298E5

Technical Supervisor

Blender

THE RESULTS DETAILED AND DETERMINATION JUDGED IN THIS DOCUMENT REFLECT THE FINDINGS OF PRO QC INTERNATIONAL AT THE TIME AND PLACE OF INSPECTION ONLY. EVIDENCE OF ACTUAL SHIPMENT IS NEITHER OFFERED NOR IMPLIED. THIS REPORT DOES NOT RELEASE THE VENDOR OR MANUFACTURER FROM ANY OBLIGATIONS, CONTRACTUAL OR OTHERWISE, IN EFFECT WITH THE CLIENT TO REPAIR, REPLACE, OR COMPENSATE FOR ANY PRODUCT OR PART THEREOF IN WHICH DEFECTIVE CONDITIONS MIGHT HEREAFTER BE FOUND OR SUBSEQUENTLY DEVELOP. PRO QC INTERNATIONAL ASSUMES NO RESPONSIBILITY, AND SHALL IN NO WAY BE HELD LIABLE, FOR ANY DEFECTIVE CONDITIONS BEYOND THOSE CLEARLY DETECTABLE WITHIN THE LIMITS OF THE SPECIFIC INSPECTION SERVICES ORDERED BY THE CLIENT.

VENDOR

THIS DOCUMENT SERVES AS EVIDENCE THAT PRO QC INTERNATIONAL LIMITED HAS PERFORMED THE INSPECTION SERVICES DETAILED HEREIN.

2ND RE-INSPECTION

FINAL PRE-SHIPMENT INSPECTION 1ST RE-INSPECTION

INSPECTION REPORT

INSPECTION DATE

Example Company

Quality Manager

REPORT NUMBERPAGE

MANUFACTURER

INSP LOCATION

OTHER:

Passed

123456

Black / Red

Pcs

APPLICABLE REMARKSPower cord length is 87cm.Black 2568pcs, Red 2568pcs

PassedFailedOn HoldFailed / On HoldMis-Inspection

CLIENTATTENTION 1 OFTITLE

FAX NUMBER

CC TO

TITLE

FAX NUMBER

TYPE OF

SERVICE X

REFERENCE Page 2~5 Page Page Page PagePRODUCT DESCRIPTION

PART NUMBER

COLOR / FINISH

SPEC / REVP.O. NUMBER

UNIT OF MEASURE

Booking / Cartons Qty

15,000 125

Actual / Cartons Qty 15,000 125

INSPECTION RESULT

SEE NOTE NUMBER

REFERENCE Page Page Page Page PagePRODUCT DESCRIPTION

PART NUMBERCOLOR / FINISH

SPEC / REVP.O. NUMBER

UNIT OF MEASURE

Booking / Cartons QtyActual / Cartons QtyINSPECTION RESULT

SEE NOTE NUMBER

Number123456

No information about unit weight provided by the client.No tension meter provided by factory for tension test.

Total inspected was 1918 pcs. The inspector found defects in 1118 pcs. Refer to page 4.Shortage in 1 carton with only 118pcs.Cartons are all compressed when inspector arrived at factory .

APPLICABLE REMARKS

No information about shipping mark & label provided by the client.

1/2,3,4,5,6

Each

Brown

Failed / On Hold

123456

ABC123

MANUFACTURER

INSP LOCATION

OTHER: 100% inspection

INSPECTION REPORT

INSPECTION DATE

Example Company

Quality Manager

REPORT NUMBERPAGE

THE RESULTS DETAILED AND DETERMINATION JUDGED IN THIS DOCUMENT REFLECT THE FINDINGS OF PRO QC INTERNATIONAL AT THE TIME AND PLACE OF INSPECTION ONLY. EVIDENCE OF ACTUAL SHIPMENT IS NEITHER OFFERED NOR IMPLIED. THIS REPORT DOES NOT RELEASE THE VENDOR OR MANUFACTURER FROM ANY OBLIGATIONS, CONTRACTUAL OR OTHERWISE, IN EFFECT WITH THE CLIENT TO REPAIR, REPLACE, OR COMPENSATE FOR ANY PRODUCT OR PART THEREOF IN WHICH DEFECTIVE CONDITIONS MIGHT HEREAFTER BE FOUND OR SUBSEQUENTLY DEVELOP. PRO QC INTERNATIONAL ASSUMES NO RESPONSIBILITY, AND SHALL IN NO WAY BE HELD LIABLE, FOR ANY DEFECTIVE CONDITIONS BEYOND THOSE CLEARLY DETECTABLE WITHIN THE LIMITS OF THE SPECIFIC INSPECTION SERVICES ORDERED BY THE CLIENT.

VENDOR

THIS DOCUMENT SERVES AS EVIDENCE THAT PRO QC INTERNATIONAL LIMITED HAS PERFORMED THE INSPECTION SERVICES DETAILED HEREIN.

2ND RE-INSPECTION

FINAL PRE-SHIPMENT INSPECTION 1ST RE-INSPECTION

Inspector / Reviewer QC Engineer

XXX00032609E

Technical Supervisor

15cm Bear Soft Toy

Passed

On Hold

1

0 1 0 1 0 1 0 1 0 1

0 0

1 YES

2 YES

3 NO

4 NO

5 NO FAILED

6 NO FAILED

7 NO FAILED

8 YES

9 N/A

10

11

12

13

14

15

PACKING METHOD 20 toys packed in 1 polybag with warning; 6 polybags packed into 1 carton.

PRODUCT LABELING Care Label- 1pc

GW = kg

W = cmH = cm

BOX STATSL = cm

H = 22.5 cmGW = 3.47 kg

L = 48 cmW = 34 cm

SHIPPING CARTON FRONT MARKINGS SHIPPING CARTON SIDE MARKINGS CTN STATS

Samples meet dimensional requirements

Process Capability

Samples meet AQL requirements

Samples meet visual requirements

Samples meet test requirements

Product was 100% produced

All required Gages were available On-Hold, Some gages were not available and some dimensions could not be verified.

Required test equipment was available On-Hold, Some test equipment was not available,and some characteristics could not be verified.

Parts were sampled from the following cartons: Total Cartons Cartons to Open

INSPECTION STATUS - REASONS ON-HOLD OR FAILED

Samples were randomly selected

Acc / Rej

AQL

MAJOR

Insp / Sample Level / Size

MINORCategory CRITICAL

1SAMPLING PLAN 3 SAMPLING PLAN 4

MAJOR MINOR CRITICAL

MAJOR MINOR

Special Level 1

CRITICAL

AQL 0

CRITICAL MAJOR

SAMPLING PLAN 1

Category

PAGE

Rev.

MINOR

SAMPLING PER 100% Inspection SINGLE NORMAL

0 0

Acc / Rej 0

ACCESSORIES

2.50 1.0

SAMPLING PLAN 2

123456

Insp / Sample Level / Size Customer Sampling Plan 100% Inspected

PRODUCT DESCRIPTION 15cm Bear Soft Toy Part Number

Report Number XXX00032609E

INSPECTION DATE

5

Passed

On Hold

PAGE

Rev.

SAMPLING PER 100% Inspection SINGLE NORMAL

123456PRODUCT DESCRIPTION 15cm Bear Soft Toy Part Number

Report Number XXX00032609E

INSPECTION DATE

RESULT

MEASURED RANGE

INSP LEVEL

SPECS AND CONDITIONS

TEST / VISUAL

RESULT Passed

MEASURED RANGE

INSP LEVEL 1 shipping carton

SPECS AND CONDITIONS

Height and drop sequence according to ISTA 1A procedure. Free fall on hard floor on one corner, three (3) edges, six (6) faces from 76 cm.

TEST / VISUALSHIPPING CARTON DROP TEST

RESULT On Hold Passed Passed

MEASURED RANGE REMARK 5 REMARK 3

INSP LEVEL

SPECS AND CONDITIONS

Product size shall match reference sample (visual comparison).

There shall be no offensive or strong smell coming from the product and no sign of mold.

Test 1 piece using both a white cotton cloth, dry and then wet to rub the material. Rub the item 10 times over a 10 cm distance with a force of 9N (1kg). There should be no color transfer greater than 4 on a grey scale after dry test and no color transfer greater than 3-4 on a grey scale after the wet test.

TEST / VISUALDIMENSIONAL CHECK ODOR CHECK COLOR MIGRATION TEST

RESULT On Hold Failed On Hold

MEASURED RANGE REMARK 2 & 4 REMARK 1 REMARK 6

INSP LEVEL

SPECS AND CONDITIONS

• Packing method and conditions • Shipping marks / labels and their position • Quantity of items within the package

• Product appearance, cosmetics & cleanliness • Logo, labels & markings• Warnings

1) Test any small, rigid parts such as: ears, ribbon and bell, etc. If the part is >6 mm thick, use 90N of force. If the part is <= 6 mm thick, use 50 N of force. 2) Slowly apply the pull force within 5 seconds and continue for 10s. Any broken seam must withstand finger-insert test with 10 N force.

TEST / VISUALPACKING VISUAL CHECK PRODUCT VISUAL CHECK TENSION (PULL) TEST VISUAL INTERNAL CHECK

Verify that the component materials are the same as specified / approved. Filling materials shall not contain any hard or sharp contaminants that can create hazardous injuries. The stuffing used must be new, clean and dry.

On Hold

Passed

SHIPPING CARTON STACKING TEST

One column of export carton will be piled up to a height of 2.5m for four hours. After the test, the lowest carton will be inspected and the result must show no compression by more than 1/10 of the total carton box height and no damage to the inside product.

Passed

On Hold

PAGE

Rev.

SAMPLING PER 100% Inspection SINGLE NORMAL

123456PRODUCT DESCRIPTION 15cm Bear Soft Toy Part Number

Report Number XXX00032609E

INSPECTION DATE

Acc/Rej 0 1 0 17656334947200

Rej TOTAL

Acc/Rej 0 1 0 1000000

TOTAL

Acc/Rej 0 000000

TOTAL YESAcc/Rej 0 0

00000

TOTAL

ok

INSP LEVELINSP LEVEL

Spec + Tol - Tol Feature 1 2 3 4 5 6 7

1 23.10 Unit Weight 22.30 22.30 22.80 22.60 22.50 5 72

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

8 See Key Above

SAMPLE SIZE Critical Dim's Acc / RejGages Used:

1 = Above Upper Specification Limit2 = Below Lower Specification Limit3 = At Upper Specification Limit4 = At Lower Specification Limit5 = Range Too Wide

Parts were measured at the specification limit. The process is not capable, and the shipment may contain non-conforming product. Additonally, due to acceptabe Gage

R&R, the measurements could be out of specificaiton.

The sample size is too small to be statistically valid; however, the measurements indicate the process

may not be capable and the shipment may contain non-conforming parts.

6 = Process Mean near Upper Specification Limit7 = Process Mean near Lower Specification Limit8 = Fails the Gage; Thread Gage; Go/No-Go; Etc

SUPPORTING INSPECTION DATASAMPLE SIZE Normal Dim's Acc / Rej

All measured parts are within the specification range.

KEY: Items 3 & 4: Items 5, 6, 7:

0 0 0

0 0 0SAMPLING PLAN 4 0 DEFECTS FOUND 0

SAMPLING PLAN 3 0 DEFECTS FOUND 0

0 0 0

SAMPLING PLAN 2 Special Level 1 DEFECTS FOUND 0 1

0 134 984

Broken hole (F.23) 2

Untrimmed thread ends on body ( F.13 - F.17) 34Untrimmed thread ends on clothes ( F.18 - F.22) 947

Label didn’t cut well( F.6 - F.10) 56Dirty mark ( F.11-F.12) 3

0 1Broken stitching( F.1 - F.5) 76

1SAMPLING PLAN 1 MINORCustomer Sampling Plan DEFECTS FOUND CRITICAL MAJOR

PAGE

0

1

2

1 Above USL

2 Below LSL

3 At USL

4 At LSL

5 Range Too Wide

6 Mean Near USL

7 Mean Near LSL

8 Fails Gage

ANALYSIS OF MEASUREMENTS

2 Decimal Places

3 Decimal Places

Gage or Test Equipment

Measurement Range/Size

Resolution/Type

Calibration Due Date

Owned by

N/A N/A N/A N/A N/A Photograph of Special Gages

REFERENCE PHOTOS FOR JOB # XXX00032609E Photo Removed Signed report showing the inspection results were reviewed with the factory.

Integrity declaration

F. Defects

F.1 Broken stitching

F.2 Broken stitching

Photo Removed F.3 Broken stitching

F.4 Broken stitching

F.5 Broken stitching

Photo Removed F.6 Label didn’t cut well.

Additional photos were removed from this example report. Photos generally include detailed product views, packaging, labeling and any defects noted.

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