Paperwork Reduction Act Statement: The information that is submitted is used to improve the Aircraft Certification Quality System Audit (QSA) including the associated training. A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0605. Public reporting for this collection of information is estimated to be approximately 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. Although not mandatory, it is requested that this form be completed within thirty (30) days after the completion of the evaluation. Send comments regarding this burden estimat or any o aspect of this collection of information, including suggestions for reducing this burden to should be directed to the FAA at: 800 Independence Ave SW, Washington, DC 20591, Attn: Information e ther Collection Clearance Officer, ASP-110. Privacy Act Statement: Information on this form is solicited under authority of 14 CFR Part 183. The purpose of this information is to evaluate your application and establish your qualifications as a designee. Submission of the data is m mandatory except for your Social Security Number which is voluntary. Incomplete submission may result in delay or denial of your request. The data will be used to determine your eligibility for the designation sought, and will become part of the Privacy Act system of records DOT/FAA 830, Representatives of the Administrator, and is subject to the following routine uses as published in the Federal Register: (1) To provide the public with the names and addresses of certain categories of representatives who may provide service to them; and (2) DOT's Prefatory Statement of General Routine Uses. The submission of your social security number is voluntary. If provided, it will be used for record keeping purposes and to help prevent your records from being confused with another person of the same name. Form Approved OMB No. 2120-0605 Expiration Date 10/31/2018 QUALITY SYSTEM AUDIT FEEDBACK REPORT QSA No. Name of Audited Facility: Dates Audited: As part of the Federal Aviation Administration (FAA) and industry continuous improvement efforts for the Quality System Audit (QSA), this form is provided for your use in furnishing the FAA with comments regarding the conduct of the audit recently conducted at your facility. We sincerely encourage you to tell us how we did, and thank you for the time you will take to support our quality improvement and customer service objectives. Please check the appropriate rating in each of the tables below, and provide any comments that you deem appropriate. 1. Pre-audit arrangements � Timeliness � Coordination/Planning Comments/recommendations for improvement: Unsatisfactory Poor Satisfactory Good Excellent 2. Pre-audit conference � � � Communication Presentation Purpose of audit explained Unsatisfactory Poor Satisfactory Good Excellent Comments/recommendations for improvement: FAA Form 8100-7 (09/12) FOR OFFICIAL USE ONLY Public availability to be determined under 5 U.S.C. 552 American LegalNet, Inc. www.FormsWorkFlow.com QUALITY SYSTEM AUDIT FEEDBACK REPORT, con't 3. Daily meetings � � Explanation of noncompliances Resolution of issues Unsatisfactory Poor Satisfactory Good Excellent Comments/recommendations for improvement: 4. Post-audit conference � Communication � Explanation of executive summary � Explanation of follow -up actions Comments/recommendations for improvement: Unsatisfactory Poor Satisfactory Good Excellent 5. Conduct of the audit � Team professionalism � Overall conduct of the QSA team Comments/recommendations for improvement: Unsatisfactory Poor Satisfactory Good Excellent Signature (optional) Date Please return completed form to: FAA Form 8100-7 (09/12) FOR OFFICIAL USE ONLY Public availability to be determined under 5 U.S.C. 552 American LegalNet, Inc. www.FormsWorkFlow.com