Cleaning Questionnaire

Name

Title

Company

Address

City

State

Zip Code

Phone

Direct Dial

Fax

Other Contact

Process Name

Tool manufacturer, Model name

Identity of contamination on the returned part(s)

Location of the part(s) in the tool

Number of cycles the part(s) sees before discarding

Amount or thickness of material deposited on part(s

Current cleaning process, if any

Identify the original source of material

Identity of the base material in which the contamination is deposited on

Number of part(s) contaminated per month/year

Estimated cost of new part(s)

Special packaging, if required

Identify critical dimensional tolerances required after cleaning

Any specific elements that need to appear on GDMS test report