Supplier Performance Report

* = denotes required field

Report Completed by: *
Phone: *
Email: *
Purchase Order No.:
Account/Requisition No: (Supplier Information)
Company: *
Zip: -
Positive Report

Select the Appropriate Box or Boxes about the Supplier:

Deliveries were made when expected Responded to complaints in a timely manner
Responded to our needs Guarantees were fulfilled
Responded to installation questions Other (Explain Below)
Detailed explanation:

Problem Report

Select the Appropriate Box or Boxes:

Unauthorized substitutions Services not performed according to specifications
Invoice incorrect Late Delivery
Unsatisfactory installation Overshipment
Unauthorized delivery Received in damaged condition
Undershipment Delivered to the wrong address
Warranty was not honored Product does not meet specifications (wrong product)
Inferior/defective merchandise Installation was difficult because the
supplier did not provide sufficient support
Other (Explain Below)
Detailed explanation:

What action has the department taken to resolve problem:

What action has the supplier taken to resolve the problem:

Please check here if the resolution was unsatisfactory.


When you submit this form a copy of the Supplier Performance Report will be emailed to the EPIC email account. The EPIC helpdesk will forward your message to the appropriate Purchasing Contract Manager for resolution and the Contract Manager or one of their staff will contact you. Please print a copy of this form for your department's records.

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