| # | Requirement | Yes | No | N/A | Objective Evidence / Comments |
|---|---|---|---|---|---|
| 1 | All required tests were performed in accordance with the approved test method. | ||||
| 2 | Raw data, calculations, and results are complete, accurate, and legible. | ||||
| 3 | Test results meet established specifications or approved acceptance criteria. | ||||
| 4 | Any OOS or OOT results have been identified and investigated per procedure. | ||||
| 5 | All required technical and quality reviews have been completed prior to disposition. |
| Performed By | Date | Signature |
|---|---|---|
| QA Approval | Date | Signature |