Atlassian uses cookies to improve your browsing experience, perform analytics and research, and conduct advertising. Accept all cookies to indicate that you agree to our use of cookies on your device.
Atlassian uses cookies to improve your browsing experience, perform analytics and research, and conduct advertising. Accept all cookies to indicate that you agree to our use of cookies on your device. Atlassian cookies and tracking notice, (opens new window)
Please complete this form for a new supplier
An approved Supplier Qualification form is required for registering the Supplier in SAP Business One.
Required fields are marked with an asterisk*
{"xsrfToken":"dc1cd8d60ea91c342462fd6d67333e87bdc7d372_lout","branding":{"id":"15","key":"dqssa","name":"DIS-QMS-Supplier Qualification","portalBaseUrl":"/servicedesk/customer/portal/15"},"helpCenterBranding":{"logoUrl":"https://api.media.atlassian.com/file/f925b350-18c2-4712-9250-9545cf6e1bbc/image/cdn?token=eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiI5MTM5MTgyZS1jZDE3LTRhN2MtOWI0Zi1lNjg3ZDE2Zjk4NGIiLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTpmaWxlOmY5MjViMzUwLTE4YzItNDcxMi05MjUwLTk1NDVjZjZlMWJiYyI6WyJyZWFkIl19LCJleHAiOjE3OTEyMjEwMjEsIm5iZiI6MTc5MTIyMDQyMX0.anDv-yOgj_yPjDOpR8iXhPQUtQgBJ1owhjoBxLXk0MA&client=9139182e-cd17-4a7c-9b4f-e687d16f984b&mode=fit","logoId":"f925b350-18c2-4712-9250-9545cf6e1bbc","isLogoAvailable":true,"helpCenterTitle":".","sharedPortalName":"Help Center","userInitialAnnouncementHeader":"","userInitialAnnouncementMessageWiki":"","translations":{"pt-PT":{"localeDisplayName":"Portuguese (Portugal)"},"en-US":{"helpCenterTitle":".","sharedPortalName":"Help Center","localeDisplayName":"English (United States)"}},"canEditAnnouncement":false,"siteDefaultLanguageTag":"en-US","userLanguageTag":"en-US","portalThemeColor":"#205185","helpCenterTitleColor":"#ffffff","bannerMediaApiUrl":"https://api.media.atlassian.com/file/cc12ed20-321d-496a-9da6-3ea396569fff/image/cdn?token=eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiI5MTM5MTgyZS1jZDE3LTRhN2MtOWI0Zi1lNjg3ZDE2Zjk4NGIiLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTpmaWxlOmNjMTJlZDIwLTMyMWQtNDk2YS05ZGE2LTNlYTM5NjU2OWZmZiI6WyJyZWFkIl19LCJleHAiOjE3OTEyMjEwMjEsIm5iZiI6MTc5MTIyMDQyMX0.gy0PCXRyRoyM7nFHJxi6ymIAGzgNn2xQlQLfncgb1tw&client=9139182e-cd17-4a7c-9b4f-e687d16f984b&height=300&mode=fit","bannerMediaApiFileId":"cc12ed20-321d-496a-9da6-3ea396569fff","useDefaultBanner":false,"isBannerAvailable":true,"topBarColor":"#ffffff","topBarTextColor":"#205185","hasTopBarBeenSplit":true},"portal":{"id":"15","key":"dqssa","projectId":10044,"serviceDeskId":15,"name":"DIS-QMS-Supplier Qualification","description":"<p>Welcome!! Here you can submit a request to qualify a new supplier</p>","portalBaseUrl":"/servicedesk/customer/portal/15","onlyPortal":false,"reqTypes":[{"id":"163","name":"Supplier Qualification","descriptionHtml":"<p>Please complete this form for a new supplier<br> An approved Supplier Qualification form is required for registering the Supplier in SAP Business One.</p>","callToAction":"Supplier Qualification","introHtml":"","icon":10550,"iconUrl":"https://delftimaging.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10550","groups":[33],"key":""},{"id":"157","name":"Change Management Request","descriptionHtml":"<p>Change management is a systematic approach in dealing with the transition or transformation of an organization's QMS processes and documentation.</p>\n<p>The purpose of change management is to implement methods for assessing change, effecting change, controlling change and successful implementing the change in the QMS.</p>\n<p>Specifically for Delft Imaging Systems, as we are in the medical device industry, all changes must be assessed in terms of risk and impact on regulatory requirements.</p>","callToAction":"Change Management Request","introHtml":"<p>Request a changes including changes to a process, documentation, product country registration or product documentation</p>","icon":10550,"iconUrl":"https://delftimaging.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10550","groups":[],"key":""},{"id":"158","name":"Corrective & Preventive Action","descriptionHtml":"","callToAction":"Corrective & Preventive Action","introHtml":"<p>Open a Corrective and Preventive Action for QMS issues or customer issues</p>","icon":10469,"iconUrl":"https://delftimaging.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10469","groups":[],"key":""},{"id":"159","name":"Critical Supplier Performance Review","descriptionHtml":"<p>A critical supplier is a supplier that delivers materials, components, or services that may influence the safety and performance of the medical device.</p>\n<p>The review rating is scored as below</p>\n<p>Excellent 25</p>\n<p>Acceptable 20</p>\n<p>Needs improvement 10</p>\n<p>Not acceptable 5</p>\n<p>The review pass score is >=80%. A score <80 shall trigger a Corrective and Preventive Action to improve the performance of the supplier in the areas(s) identified as Needs Improvement and/or Not Acceptable.</p>","callToAction":"Critical Supplier Performance Review","introHtml":"<p>Review performance of a critical supplier</p>","icon":10550,"iconUrl":"https://delftimaging.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10550","groups":[],"key":""},{"id":"165","name":"Emailed request","descriptionHtml":"","callToAction":"Emailed request","introHtml":"<p>Request received from your email support channel.</p>","icon":10527,"iconUrl":"https://delftimaging.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10527","groups":[],"key":""},{"id":"160","name":"Medical Device/Material Verification Checklist","descriptionHtml":"<p>Per the Medical Device Regulation, the verification checklist is a mandatory document for all types of medical devices or material that could have an impact or may pose a risk.</p>\n<p>The Medical Device Verification Checklist acts as documented evidence (record) to demonstrate that a product or part is safe for its intended use and effectively fulfills the required purpose.</p>\n<p>This activity forms a critical part of the material and item (part) number approval process, so the request must be submitted and approved, prior to item (part) number approval in SAP Business One.</p>\n<p>Please attach supporting documentation including CE declarations, technical specifications, material safety data sheet (MSDS) or other regulatory documents (as available).</p>\n<p>Required documents to attach: IFU (User Manual) and CE declaration.</p>\n<p>Any questions on this form or how to complete please contact the Quality Assurance Manager</p>","callToAction":"Medical Device/Material Verification Checklist","introHtml":"<p>Submit a product or part specification to verify its safe for its intended use and effectively fulfills the required purpose per regulatory requirements.</p>","icon":10550,"iconUrl":"https://delftimaging.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10550","groups":[],"key":""},{"id":"161","name":"QMS Audit Planner","descriptionHtml":"<p>We plan internal audits and develop audit schedules</p>\n<p>The purpose of an audit is to:</p>\n<ul class=\"alternate\" type=\"square\">\n <li>make sure that the processes are meeting the planned arrangements and regulatory requirements that are identified for the process in the QMS, and any requirements that the ISO 13485:2016 standard has in place for that process</li>\n</ul>\n<ul class=\"alternate\" type=\"square\">\n <li>make sure that the process is implemented and maintained effectively</li>\n</ul>","callToAction":"QMS Audit Planner","introHtml":"<p>Request and plan an audit</p>","icon":10550,"iconUrl":"https://delftimaging.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10550","groups":[],"key":""},{"id":"166","name":"QMS Onboarding","descriptionHtml":"","callToAction":"QMS Onboarding","introHtml":"","icon":10482,"iconUrl":"https://delftimaging.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10482","groups":[],"key":""},{"id":"162","name":"Software (Tool) Validation","descriptionHtml":"","callToAction":"Software (Tool) Validation","introHtml":"<p>Software (tools) interact with our QMS. Here you can submit a software tool to assess risk to the medical device product and identify validation actions, if any are required, for this software tool</p>","icon":10550,"iconUrl":"https://delftimaging.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10550","groups":[],"key":""},{"id":"164","name":"Training Related","descriptionHtml":"<p>Here you can submit any type of record of training completed. This can be record of attendance, training report, exam result or certificate<br> You can also submit any training session you have planned</p>","callToAction":"Training Related","introHtml":"<p>Submit record of training, certification for record keeping</p>","icon":10550,"iconUrl":"https://delftimaging.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10550","groups":[],"key":""}],"reqGroups":[{"id":33,"name":"Supplier Qualification"}],"orderMapping":{"33":[163]},"kbs":{"kbEnabled":false,"serviceDeskId":-1},"createPermission":true,"portalAnnouncement":{"portalId":15,"canEditAnnouncement":false,"canAdministerProject":false,"portalProjectKey":"DQSSA","userLanguageHeader":"","userLanguageMessageWiki":"","defaultLanguageHeader":"","defaultLanguageMessage":"","defaultLanguageDisplayName":"English (United States)","isUsingLanguageSupport":false,"translations":{}},"canViewCreateRequestForm":true,"isProjectSimplified":false,"mediaApiUploadInformation":{"token":"eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiI5MTM5MTgyZS1jZDE3LTRhN2MtOWI0Zi1lNjg3ZDE2Zjk4NGIiLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTp1cGxvYWQ6KiI6WyJyZWFkIiwiY3JlYXRlIiwidXBkYXRlIl0sInVybjpmaWxlc3RvcmU6Y29sbGVjdGlvbjp1cGxvYWQtdXNlci1jb2xsZWN0aW9uLS0zOTc4NzA1OCI6WyJyZWFkIiwiY3JlYXRlIiwidXBkYXRlIl0sInVybjpmaWxlc3RvcmU6Y2h1bms6KiI6WyJyZWFkIiwiY3JlYXRlIl19LCJleHAiOjE3OTEyMjE2MjEsIm5iZiI6MTc5MTIyMDQyMSwiYW5vbklkIjoiYW5vbi11c2VyIiwiaHR0cHM6Ly9pZC5hdGxhc3NpYW4uY29tL2FwcEFjY3JlZGl0ZWQiOmZhbHNlfQ.5R7hsFr57o3Q6626GMGjsbV_D29-d8bsOL7aW2sh-V0","targetCollection":"upload-user-collection--39787058","endpointUrl":"https://api.media.atlassian.com","clientId":"9139182e-cd17-4a7c-9b4f-e687d16f984b","tokenDurationInMins":20},"locale":"en-US","i18nTranslations":{}},"reqCreate":{"id":163,"projectId":10044,"issueType":{"id":"10041","name":"Supplier Review"},"form":{"name":"Supplier Qualification","descriptionHtml":"<p>Please complete this form for a new supplier<br/>\nAn approved Supplier Qualification form is required for registering the Supplier in SAP Business One.</p>","callToAction":"Supplier Qualification","intro":"","instructions":"<p>Please complete this form for a new supplier<br/>\nAn approved Supplier Qualification form is required for registering the Supplier in SAP Business One.</p>","icon":10550,"iconUrl":"https://delftimaging.atlassian.net/rest/servicedeskapi/requesttype/icon/type/SD_REQTYPE/id/10550","key":""},"fields":[{"fieldType":"text","fieldId":"email","fieldConfigId":"","label":"Email confirmation to","description":"","descriptionHtml":"","required":true,"displayed":true,"presetValues":[]},{"fieldType":"text","jiraFieldType":"com.atlassian.jira.plugin.system.customfieldtypes:textfield","fieldId":"customfield_10155","fieldConfigId":"10261","label":"Manufacturer or Service Provider Name:","description":"For components or tangible goods the supplier is the legal manufacturer. For services the supplier is the service provider.","descriptionHtml":"<p>For components or tangible goods the supplier is the legal manufacturer. For services the supplier is the service provider.</p>","required":true,"displayed":true,"presetValues":[]},{"fieldType":"text","jiraFieldType":"summary","fieldId":"summary","fieldConfigId":"","label":"Summary","description":"","descriptionHtml":"","required":true,"displayed":false,"presetValues":["Supplier Qualification"]},{"fieldType":"select","jiraFieldType":"com.atlassian.jira.plugin.system.customfieldtypes:select","fieldId":"customfield_10213","fieldConfigId":"10322","label":"With its business legally registered in:","description":"Country where supplier is legally registered","descriptionHtml":"<p>Country where supplier is legally registered</p>","required":true,"displayed":true,"presetValues":[],"values":[{"value":"10446","label":"Afghanistan","selected":false,"children":[]},{"value":"10447","label":"Albania","selected":false,"children":[]},{"value":"10448","label":"Algeria","selected":false,"children":[]},{"value":"10449","label":"Andorra","selected":false,"children":[]},{"value":"10450","label":"Angola","selected":false,"children":[]},{"value":"10451","label":"Antigua and Barbuda","selected":false,"children":[]},{"value":"10452","label":"Argentina","selected":false,"children":[]},{"value":"10453","label":"Armenia","selected":false,"children":[]},{"value":"10454","label":"Austria","selected":false,"children":[]},{"value":"10455","label":"Azerbaijan","selected":false,"children":[]},{"value":"10456","label":"Bahrain","selected":false,"children":[]},{"value":"10457","label":"Bangladesh","selected":false,"children":[]},{"value":"10458","label":"Barbados","selected":false,"children":[]},{"value":"10459","label":"Belarus","selected":false,"children":[]},{"value":"10460","label":"Belgium","selected":false,"children":[]},{"value":"10461","label":"Belize","selected":false,"children":[]},{"value":"10462","label":"Benin","selected":false,"children":[]},{"value":"10463","label":"Bhutan","selected":false,"children":[]},{"value":"10464","label":"Bolivia","selected":false,"children":[]},{"value":"10465","label":"Bosnia and Herzegovina","selected":false,"children":[]},{"value":"10466","label":"Botswana","selected":false,"children":[]},{"value":"10467","label":"Brazil","selected":false,"children":[]},{"value":"10468","label":"Brunei","selected":false,"children":[]},{"value":"10469","label":"Bulgaria","selected":false,"children":[]},{"value":"10470","label":"Burkina Faso","selected":false,"children":[]},{"value":"10471","label":"Burundi","selected":false,"children":[]},{"value":"10472","label":"Cabo Verde","selected":false,"children":[]},{"value":"10473","label":"Cambodia","selected":false,"children":[]},{"value":"10474","label":"Cameroon","selected":false,"children":[]},{"value":"10475","label":"Canada","selected":false,"children":[]},{"value":"10476","label":"Central African Republic","selected":false,"children":[]},{"value":"10477","label":"Chad","selected":false,"children":[]},{"value":"10478","label":"Channel Islands","selected":false,"children":[]},{"value":"10479","label":"Chile","selected":false,"children":[]},{"value":"10480","label":"China","selected":false,"children":[]},{"value":"10481","label":"Colombia","selected":false,"children":[]},{"value":"10482","label":"Comoros","selected":false,"children":[]},{"value":"10483","label":"Congo","selected":false,"children":[]},{"value":"10484","label":"Costa Rica","selected":false,"children":[]},{"value":"10486","label":"Croatia","selected":false,"children":[]},{"value":"10487","label":"Cuba","selected":false,"children":[]},{"value":"10488","label":"Cyprus","selected":false,"children":[]},{"value":"10489","label":"Czech Republic (Czechia)","selected":false,"children":[]},{"value":"10485","label":"Côte d'Ivoire (Ivory Coast)","selected":false,"children":[]},{"value":"10490","label":"Denmark","selected":false,"children":[]},{"value":"10491","label":"Djibouti","selected":false,"children":[]},{"value":"10492","label":"Dominica","selected":false,"children":[]},{"value":"10493","label":"Dominican Republic","selected":false,"children":[]},{"value":"10494","label":"DR Congo","selected":false,"children":[]},{"value":"10495","label":"Ecuador","selected":false,"children":[]},{"value":"10496","label":"Egypt","selected":false,"children":[]},{"value":"10497","label":"El Salvador","selected":false,"children":[]},{"value":"10498","label":"Equatorial Guinea","selected":false,"children":[]},{"value":"10499","label":"Eritrea","selected":false,"children":[]},{"value":"10500","label":"Estonia","selected":false,"children":[]},{"value":"10501","label":"Eswatini","selected":false,"children":[]},{"value":"10502","label":"Ethiopia","selected":false,"children":[]},{"value":"10503","label":"Faeroe Islands","selected":false,"children":[]},{"value":"10504","label":"Finland","selected":false,"children":[]},{"value":"10505","label":"France","selected":false,"children":[]},{"value":"10506","label":"French Guiana","selected":false,"children":[]},{"value":"10507","label":"Gabon","selected":false,"children":[]},{"value":"10508","label":"Gambia","selected":false,"children":[]},{"value":"10509","label":"Georgia","selected":false,"children":[]},{"value":"10510","label":"Germany","selected":false,"children":[]},{"value":"10511","label":"Ghana","selected":false,"children":[]},{"value":"10512","label":"Gibraltar","selected":false,"children":[]},{"value":"10513","label":"Greece","selected":false,"children":[]},{"value":"10514","label":"Grenada","selected":false,"children":[]},{"value":"10515","label":"Guatemala","selected":false,"children":[]},{"value":"10516","label":"Guinea","selected":false,"children":[]},{"value":"10517","label":"Guinea-Bissau","selected":false,"children":[]},{"value":"10518","label":"Guyana","selected":false,"children":[]},{"value":"10519","label":"Haiti","selected":false,"children":[]},{"value":"10520","label":"Holy See (Vatican City)","selected":false,"children":[]},{"value":"10521","label":"Honduras","selected":false,"children":[]},{"value":"10522","label":"Hong Kong","selected":false,"children":[]},{"value":"10523","label":"Hungary","selected":false,"children":[]},{"value":"10524","label":"Iceland","selected":false,"children":[]},{"value":"10525","label":"India","selected":false,"children":[]},{"value":"10526","label":"Indonesia","selected":false,"children":[]},{"value":"10527","label":"Iran","selected":false,"children":[]},{"value":"10528","label":"Iraq","selected":false,"children":[]},{"value":"10529","label":"Ireland","selected":false,"children":[]},{"value":"10530","label":"Isle of Man","selected":false,"children":[]},{"value":"10531","label":"Israel","selected":false,"children":[]},{"value":"10532","label":"Italy","selected":false,"children":[]},{"value":"10533","label":"Jamaica","selected":false,"children":[]},{"value":"10534","label":"Japan","selected":false,"children":[]},{"value":"10535","label":"Jordan","selected":false,"children":[]},{"value":"10536","label":"Kazakhstan","selected":false,"children":[]},{"value":"10537","label":"Kenya","selected":false,"children":[]},{"value":"10538","label":"Kuwait","selected":false,"children":[]},{"value":"10539","label":"Kyrgyzstan","selected":false,"children":[]},{"value":"10540","label":"Laos","selected":false,"children":[]},{"value":"10541","label":"Latvia","selected":false,"children":[]},{"value":"10542","label":"Lebanon","selected":false,"children":[]},{"value":"10543","label":"Lesotho","selected":false,"children":[]},{"value":"10544","label":"Liberia","selected":false,"children":[]},{"value":"10545","label":"Libya","selected":false,"children":[]},{"value":"10546","label":"Liechtenstein","selected":false,"children":[]},{"value":"10547","label":"Lithuania","selected":false,"children":[]},{"value":"10548","label":"Luxembourg","selected":false,"children":[]},{"value":"10549","label":"Macao","selected":false,"children":[]},{"value":"10550","label":"Madagascar","selected":false,"children":[]},{"value":"10551","label":"Malawi","selected":false,"children":[]},{"value":"10552","label":"Malaysia","selected":false,"children":[]},{"value":"10553","label":"Maldives","selected":false,"children":[]},{"value":"10554","label":"Mali","selected":false,"children":[]},{"value":"10555","label":"Malta","selected":false,"children":[]},{"value":"10556","label":"Mauritania","selected":false,"children":[]},{"value":"10557","label":"Mauritius","selected":false,"children":[]},{"value":"10558","label":"Mayotte","selected":false,"children":[]},{"value":"10559","label":"Mexico","selected":false,"children":[]},{"value":"10560","label":"Moldova","selected":false,"children":[]},{"value":"10561","label":"Monaco","selected":false,"children":[]},{"value":"10562","label":"Mongolia","selected":false,"children":[]},{"value":"10563","label":"Montenegro","selected":false,"children":[]},{"value":"10564","label":"Morocco","selected":false,"children":[]},{"value":"10565","label":"Mozambique","selected":false,"children":[]},{"value":"10566","label":"Myanmar","selected":false,"children":[]},{"value":"10567","label":"Namibia","selected":false,"children":[]},{"value":"10568","label":"Nepal","selected":false,"children":[]},{"value":"10569","label":"Nicaragua","selected":false,"children":[]},{"value":"10570","label":"Niger","selected":false,"children":[]},{"value":"10571","label":"Nigeria","selected":false,"children":[]},{"value":"10572","label":"North Korea","selected":false,"children":[]},{"value":"10573","label":"North Macedonia","selected":false,"children":[]},{"value":"10574","label":"Norway","selected":false,"children":[]},{"value":"10575","label":"Oman","selected":false,"children":[]},{"value":"10576","label":"Pakistan","selected":false,"children":[]},{"value":"10577","label":"Panama","selected":false,"children":[]},{"value":"10639","label":"Papua New Guinea","selected":false,"children":[]},{"value":"10578","label":"Paraguay","selected":false,"children":[]},{"value":"10579","label":"Peru","selected":false,"children":[]},{"value":"10580","label":"Philippines","selected":false,"children":[]},{"value":"10581","label":"Poland","selected":false,"children":[]},{"value":"10582","label":"Portugal","selected":false,"children":[]},{"value":"10583","label":"Qatar","selected":false,"children":[]},{"value":"10585","label":"Romania","selected":false,"children":[]},{"value":"10586","label":"Russia","selected":false,"children":[]},{"value":"10587","label":"Rwanda","selected":false,"children":[]},{"value":"10584","label":"Réunion","selected":false,"children":[]},{"value":"10588","label":"Saint Helena","selected":false,"children":[]},{"value":"10589","label":"Saint Kitts and Nevis","selected":false,"children":[]},{"value":"10590","label":"Saint Lucia","selected":false,"children":[]},{"value":"10591","label":"Saint Vincent and the Grenadines","selected":false,"children":[]},{"value":"10592","label":"San Marino","selected":false,"children":[]},{"value":"10593","label":"Sao Tome & Principe","selected":false,"children":[]},{"value":"10594","label":"Saudi Arabia","selected":false,"children":[]},{"value":"10595","label":"Senegal","selected":false,"children":[]},{"value":"10596","label":"Serbia","selected":false,"children":[]},{"value":"10597","label":"Seychelles","selected":false,"children":[]},{"value":"10598","label":"Sierra Leone","selected":false,"children":[]},{"value":"10599","label":"Singapore","selected":false,"children":[]},{"value":"10600","label":"Slovakia","selected":false,"children":[]},{"value":"10601","label":"Slovenia","selected":false,"children":[]},{"value":"10602","label":"Somalia","selected":false,"children":[]},{"value":"10603","label":"South Africa","selected":false,"children":[]},{"value":"10604","label":"South Korea","selected":false,"children":[]},{"value":"10605","label":"South Sudan","selected":false,"children":[]},{"value":"10606","label":"Spain","selected":false,"children":[]},{"value":"10607","label":"Sri Lanka","selected":false,"children":[]},{"value":"10608","label":"State of Palestine","selected":false,"children":[]},{"value":"10609","label":"Sudan","selected":false,"children":[]},{"value":"10610","label":"Suriname","selected":false,"children":[]},{"value":"10611","label":"Sweden","selected":false,"children":[]},{"value":"10612","label":"Switzerland","selected":false,"children":[]},{"value":"10613","label":"Syria","selected":false,"children":[]},{"value":"10614","label":"Taiwan","selected":false,"children":[]},{"value":"10615","label":"Tajikistan","selected":false,"children":[]},{"value":"10616","label":"Tanzania","selected":false,"children":[]},{"value":"10617","label":"Thailand","selected":false,"children":[]},{"value":"10618","label":"The Bahamas","selected":false,"children":[]},{"value":"10619","label":"The Netherlands","selected":false,"children":[]},{"value":"10620","label":"Timor-Leste","selected":false,"children":[]},{"value":"10621","label":"Togo","selected":false,"children":[]},{"value":"10622","label":"Trinidad and Tobago","selected":false,"children":[]},{"value":"10623","label":"Tunisia","selected":false,"children":[]},{"value":"10624","label":"Turkey (Türkiye)","selected":false,"children":[]},{"value":"10625","label":"Turkmenistan","selected":false,"children":[]},{"value":"10626","label":"Uganda","selected":false,"children":[]},{"value":"10627","label":"Ukraine","selected":false,"children":[]},{"value":"10628","label":"United Arab Emirates","selected":false,"children":[]},{"value":"10629","label":"United Kingdom","selected":false,"children":[]},{"value":"10630","label":"United States","selected":false,"children":[]},{"value":"10631","label":"Uruguay","selected":false,"children":[]},{"value":"10632","label":"Uzbekistan","selected":false,"children":[]},{"value":"10633","label":"Venezuela","selected":false,"children":[]},{"value":"10634","label":"Vietnam","selected":false,"children":[]},{"value":"10635","label":"Western Sahara","selected":false,"children":[]},{"value":"10636","label":"Yemen","selected":false,"children":[]},{"value":"10637","label":"Zambia","selected":false,"children":[]},{"value":"10638","label":"Zimbabwe","selected":false,"children":[]}],"noneOptionRequired":true},{"fieldType":"multiselect","jiraFieldType":"com.atlassian.jira.plugin.system.customfieldtypes:multiselect","fieldId":"customfield_10838","fieldConfigId":"11108","label":"Supplier Type","description":"","descriptionHtml":"","required":false,"displayed":true,"presetValues":[],"values":[{"value":"11525","label":"Component, Material or Device","selected":false,"children":[]},{"value":"11526","label":"Services","selected":false,"children":[]}]},{"fieldType":"attachment","jiraFieldType":"attachment","fieldId":"attachment","fieldConfigId":"","label":"Attachment","description":"","descriptionHtml":"","required":false,"displayed":true,"presetValues":[]}],"userOrganisations":[],"canBrowseUsers":false,"requestCreateBaseUrl":"/servicedesk/customer/portal/15/create/163","requestValidateBaseUrl":"/servicedesk/customer/portal/15/validate/163","calendarParams":{"firstDay":0,"date":"2026-10-05T17:13:41+0000","useISO8601WeekNumbers":true,"dateIfFormat":"%e/%b/%y","dateTimeIfFormat":"%e/%b/%y %I:%M %p","timeFormat":"12"},"kbs":{"kbEnabled":false,"serviceDeskId":-1},"canRaiseOnBehalf":false,"canSignupCustomers":false,"canCreateAttachments":true,"attachmentRequiredField":false,"hasGroups":true,"canSubmitWithEmailAddress":false,"showRecaptcha":true,"siteKey":"6LePXLkdAAAAAF4gCNalrL1IvZcqbNbZf_Zakudd","mediaApiUploadInformation":{"token":"eyJhbGciOiJIUzI1NiJ9.eyJpc3MiOiI5MTM5MTgyZS1jZDE3LTRhN2MtOWI0Zi1lNjg3ZDE2Zjk4NGIiLCJhY2Nlc3MiOnsidXJuOmZpbGVzdG9yZTp1cGxvYWQ6KiI6WyJyZWFkIiwiY3JlYXRlIiwidXBkYXRlIl0sInVybjpmaWxlc3RvcmU6Y29sbGVjdGlvbjp1cGxvYWQtdXNlci1jb2xsZWN0aW9uLS0zOTc4NzA1OCI6WyJyZWFkIiwiY3JlYXRlIiwidXBkYXRlIl0sInVybjpmaWxlc3RvcmU6Y2h1bms6KiI6WyJyZWFkIiwiY3JlYXRlIl19LCJleHAiOjE3OTEyMjE2MjEsIm5iZiI6MTc5MTIyMDQyMSwiYW5vbklkIjoiYW5vbi11c2VyIiwiaHR0cHM6Ly9pZC5hdGxhc3NpYW4uY29tL2FwcEFjY3JlZGl0ZWQiOmZhbHNlfQ.5R7hsFr57o3Q6626GMGjsbV_D29-d8bsOL7aW2sh-V0","targetCollection":"upload-user-collection--39787058","endpointUrl":"https://api.media.atlassian.com","clientId":"9139182e-cd17-4a7c-9b4f-e687d16f984b","tokenDurationInMins":20},"hasProformaForm":true,"proformaTemplateForm":{"id":577612966731121,"updated":"2025-12-01T10:29:59.623428145Z","publish":{"jira":{"submitOnCreate":true,"validateOnCreate":true},"portal":{"portalRequestTypeIds":[163],"submitOnCreate":true,"validateOnCreate":true}},"design":{"settings":{"templateId":577612966731121,"name":"DIS Supplier Qualification","submit":{"lock":false,"pdf":false},"templateFormUuid":"36e16829-1777-49ad-9aff-2ce7e7e3fc12"},"layout":[{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":2},"layout":"default","localId":"80403e0d-0b55-49d1-8112-b94ca6514713"}},{"type":"paragraph","content":[]}]},{"version":1,"type":"doc","content":[{"type":"paragraph","content":[]},{"type":"paragraph","content":[]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":21},"layout":"default","localId":"6c6e57c5-0251-4814-a70e-323499bc8674"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":6},"layout":"default","localId":"5254f9a8-8a8c-46b0-8fa2-47ad3ebba32a"}},{"type":"paragraph","attrs":{"localId":"1a92eda9-f05d-4c1f-b98d-b5e7b0201588"},"content":[{"type":"text","text":"QMS Supplier Criticality Questions:","marks":[{"type":"strong"}]}]},{"type":"paragraph","content":[]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":7},"layout":"default","localId":"f2497444-c7a7-463a-a59e-f11f92ee6df5"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":15},"layout":"default","localId":"16f3bd40-d335-4244-af5b-dbe97256efb2"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":16},"layout":"default","localId":"8ca5b732-54de-498f-b666-4b089d05279d"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":17},"layout":"default","localId":"e362c12a-6299-4699-8c29-94a7ea578c46"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":18},"layout":"default","localId":"c7f7527e-1a11-44da-946e-4aae27bfc379"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":20},"layout":"default","localId":"368a6551-0550-4855-aa09-86b2e5e51985"}}]}],"conditions":{"5":{"i":{"co":{"cIds":{"2":["11358"]}}},"o":{"sIds":["1"]},"t":"sh"}},"sections":{"1":{"name":"Supplier Assessment","conditions":["5"]}},"questions":{"15":{"type":"cd","label":"(2.) Could the purchased products, parts or services have an impact on the safety of the medical devices?","description":"Things to consider.. do they provide components or material, do they provide training services, do they provide helpdesk support, do they repair or service the product. If yes then they could impact the safety of the device","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"16":{"type":"cd","label":"(3.) Are we not able to distribute the medical devices without the supplier’s products, parts or services?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"21":{"type":"cm","label":"This supplier provides the following that are of interest to Delft Imaging Systems","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Service","other":false},{"id":"2","label":"Component/Part","other":false},{"id":"3","label":"Both Service and Component/Part","other":false}],"questionKey":""},"6":{"type":"rt","label":"Brief description of the product, component or service","description":"Add the company description, website and profile in here; what are the expectations from Delft Imaging i.e. what we need from this company","validation":{"rq":true},"choices":[],"questionKey":""},"17":{"type":"cd","label":"(4.) Is there no alternative and equivalent supplier for these products, parts or services?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"20":{"type":"cd","label":"(6.) The supplier has a certified ISO9001 and/or ISO13485 management system in place?","description":"If yes, attach certificate","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"2":{"type":"cd","label":"Does this supplier 1) Provide services such as outsourced training services, auditing services, installation, outsourced manufacturing, design and service support or 2) Provide material such as components, parts or systems that shall be integrated into the Delft Imaging supplied medical devices?","description":"","validation":{"rq":true},"jiraField":"customfield_10738","questionKey":""},"18":{"type":"cd","label":"(5.) Can the supplier provide regulatory and logistic information for purchased products, parts or services?","description":"This shall include for example: Declaration of Conformity or MSDS","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"7":{"type":"cd","label":"(1.) There is a non-disclosure agreement (NDA) in place with the supplier?","description":"If yes attach agreement","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""}}},"uuid":"36e16829-1777-49ad-9aff-2ce7e7e3fc12"},"proforma":{"formExists":true,"formValid":true,"formTemplateData":{"id":577612966731121,"updated":"2025-12-01T10:29:59.623428145Z","publish":{"jira":{"submitOnCreate":true,"validateOnCreate":true},"portal":{"portalRequestTypeIds":[163],"submitOnCreate":true,"validateOnCreate":true}},"design":{"settings":{"templateId":577612966731121,"name":"DIS Supplier Qualification","submit":{"lock":false,"pdf":false},"templateFormUuid":"36e16829-1777-49ad-9aff-2ce7e7e3fc12"},"layout":[{"version":1,"type":"doc","content":[{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":2},"layout":"default","localId":"80403e0d-0b55-49d1-8112-b94ca6514713"}},{"type":"paragraph","content":[]}]},{"version":1,"type":"doc","content":[{"type":"paragraph","content":[]},{"type":"paragraph","content":[]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":21},"layout":"default","localId":"6c6e57c5-0251-4814-a70e-323499bc8674"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":6},"layout":"default","localId":"5254f9a8-8a8c-46b0-8fa2-47ad3ebba32a"}},{"type":"paragraph","attrs":{"localId":"1a92eda9-f05d-4c1f-b98d-b5e7b0201588"},"content":[{"type":"text","text":"QMS Supplier Criticality Questions:","marks":[{"type":"strong"}]}]},{"type":"paragraph","content":[]},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":7},"layout":"default","localId":"f2497444-c7a7-463a-a59e-f11f92ee6df5"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":15},"layout":"default","localId":"16f3bd40-d335-4244-af5b-dbe97256efb2"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":16},"layout":"default","localId":"8ca5b732-54de-498f-b666-4b089d05279d"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":17},"layout":"default","localId":"e362c12a-6299-4699-8c29-94a7ea578c46"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":18},"layout":"default","localId":"c7f7527e-1a11-44da-946e-4aae27bfc379"}},{"type":"extension","attrs":{"extensionKey":"question","extensionType":"com.thinktilt.proforma","parameters":{"id":20},"layout":"default","localId":"368a6551-0550-4855-aa09-86b2e5e51985"}}]}],"conditions":{"5":{"i":{"co":{"cIds":{"2":["11358"]}}},"o":{"sIds":["1"]},"t":"sh"}},"sections":{"1":{"name":"Supplier Assessment","conditions":["5"]}},"questions":{"15":{"type":"cd","label":"(2.) Could the purchased products, parts or services have an impact on the safety of the medical devices?","description":"Things to consider.. do they provide components or material, do they provide training services, do they provide helpdesk support, do they repair or service the product. If yes then they could impact the safety of the device","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"16":{"type":"cd","label":"(3.) Are we not able to distribute the medical devices without the supplier’s products, parts or services?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"21":{"type":"cm","label":"This supplier provides the following that are of interest to Delft Imaging Systems","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Service","other":false},{"id":"2","label":"Component/Part","other":false},{"id":"3","label":"Both Service and Component/Part","other":false}],"questionKey":""},"6":{"type":"rt","label":"Brief description of the product, component or service","description":"Add the company description, website and profile in here; what are the expectations from Delft Imaging i.e. what we need from this company","validation":{"rq":true},"choices":[],"questionKey":""},"17":{"type":"cd","label":"(4.) Is there no alternative and equivalent supplier for these products, parts or services?","description":"","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"20":{"type":"cd","label":"(6.) The supplier has a certified ISO9001 and/or ISO13485 management system in place?","description":"If yes, attach certificate","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"2":{"type":"cd","label":"Does this supplier 1) Provide services such as outsourced training services, auditing services, installation, outsourced manufacturing, design and service support or 2) Provide material such as components, parts or systems that shall be integrated into the Delft Imaging supplied medical devices?","description":"","validation":{"rq":true},"jiraField":"customfield_10738","questionKey":""},"18":{"type":"cd","label":"(5.) Can the supplier provide regulatory and logistic information for purchased products, parts or services?","description":"This shall include for example: Declaration of Conformity or MSDS","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""},"7":{"type":"cd","label":"(1.) There is a non-disclosure agreement (NDA) in place with the supplier?","description":"If yes attach agreement","validation":{"rq":true},"choices":[{"id":"1","label":"Yes","other":false},{"id":"2","label":"No","other":false}],"questionKey":""}}},"uuid":"36e16829-1777-49ad-9aff-2ce7e7e3fc12"},"linkedJiraFields":["customfield_10738"]},"key":""},"portalWebFragments":{"headerPanels":[],"subheaderPanels":[],"footerPanels":[],"pagePanels":{"propertyPanels":[],"legacyPropertyPanels":[]}}}