Q-110-1 REV. A Page 1
CM FIRST ARTICLE INSPECTION REPORT (Q110-1)
Part No.
Rev.
Sheet
Of
Part Name:
Date:
Contract MFR:
Originator:
Work Order No.
Purchase Order No.
(If applicable)
Quantity
Shipped:
Test(s) conducted
ICT
FVT
Hi POT
Visual Inspection
ADTRAN Assembly DWGs/specification(s) used
First Article unit(s) Serial Number
Remarks:
1
st
Submission
2
nd
Submission
Tooling Rebuilt/Refurbish
Certification Of Compliance
I certify that the parts furnished on the above shipment meet all the necessary Engineering Instructions,
Mechanical Specifications and Necessary Requirements, and that the above parts have been inspected by
this Company. A copy of all working documentation used for verification to include deviation notices,
assembly and label placement drawing(s), BOM and any other written instructions shall be included with
this First Article Shipment.
Quality Manager____________________________________Date_______________
For ADTRAN use only
Disposition:
Approved
Rejected
Conditional Approval
Resubmission of 1
st
Article Required?
YES
NO
Remarks:
Q110-1 – CM First Article Inspection Report, Rev A, page 1
(Quality Record)
