| # | Requirement | Yes | No | N/A | Objective Evidence / Comments |
|---|---|---|---|---|---|
| 1 | Laboratory data entries are complete, legible, and attributable to the individual performing the activity. | ||||
| 2 | Data entries are contemporaneous and recorded at the time the activity was performed. | ||||
| 3 | Original data or true copies are retained and protected from unauthorized modification. | ||||
| 4 | Any data corrections are properly justified, documented, and approved in accordance with procedure. | ||||
| 5 | Electronic data systems and audit trails support data integrity and are reviewed as required. |
| Performed By | Date | Signature |
|---|---|---|
| QA Review | Date | Signature |