SPE # ???
(Display SPE# associated with this product)
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Manufacturer/Client (Dropdown)
Person Contacted
Name:(open Field)
Title:(open Field)
Facility Record Sheet:
(Box - Acceptable)
(Box - Revision(s) Needed)
Visit Type:
(Box - Initial Audit)
(Box - Annual Compliance Audit)
(Box - Follow Up Audit)
(Box - Agency Audit)
Evaluation Conditions: (Dropdown for below - Reviewed, Complete, Incomplete, Inventory, NA)
General and Specific Program Policies: (Dropdown)
Documentation Packages: (Dropdown)
Literature: (Dropdown)
REFER TO NARRATIVE PAGE FOR VARIATIONS
| PRODUCT TYPE | STD | MODEL NUMBER | L/ANF | SERIES NAME | EVALUATION CONDITION |
|---|---|---|---|---|---|
| (Open field) | (Open field) | (Open field) | (Open field) | (Open field) | (Open field) |
Add additional Variations <Button> (Repeat above table if selected)
This report confirms the evaluation/audit on (date below) to determine compliance with NSF/ANSI Standard(s) and all related requirements. For any non-compliance, you are requested to submit on or before (date below) a written explanation of planned and/or actual corrective action or a statement of disagreement with reasons. Gulf Coast Testing’s contract and policy prohibits the use of the Gulf Coast Testing® mark on products not in full compliance with the applicable standard and policies. Completion of this report does not constitute acceptance for Certification/Listing.
Evaluation / Audit Date: (Calendar)
Corrective Action or A Statement of Disagreement Date: (Calendar)
Inspector:
Name: (Open Field)
Date:(Calendar)
Manufacturer:
Name: (Open Field)
Date:(Calendar)
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