Subordinate protot Subordinate prototype QA Records

SUBORDINATE PROTOTYPE QA RECORDS

OMB 3041- 0133
16 CFR Part 1633 – Standard for the Flammability (Open Flame) of Mattress Sets

DATE: _____/_____/_____

Firm Name:______________________

PROTOTYPE ID: ________________________

PRODUCTION LOTS REPRESENTED BY SUBORDINATE PROTOTYPE
LOT NUMBER

START DATE

STOP DATE

QUANTITY

To complete test record requirements under § 1633.11(d) for subordinate prototypes, the information contained
herein must be accompanied by:
(1) a written copy of the manufacturer’s quality assurance procedures;
(2) records of any production tests performed, to include an assigned production lot identification
number and the identification number of the subordinate prototype associated with the specimen
tested; and
(3) component, material and assembly records, to include detailed records of technical evaluations of
components and materials and/or methods of assembly.