Surveillance Audit Form

DTI BPS form for surveillance audit form

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No.
Revision No.

SD-A05-QF16
4

Effectivity Date:
Page

23 Dec. 2011
1 of 1

BPS PRODUCT CERTIFICATION SCHEME
CERTIFIED

CERTIFIED

SURVEILLANCE AUDIT FORM

Product Quality

Product Safety

COMPANY PROFILE

CHANGES/ UPDATE
YES
NO

(accomplish this form per product and use additional sheet if necessary for the updates/changes)

Company’s Registered Name
Complete Plant Address
Telephone numbers
Facsimile numbers
President/ General Manager
Contact Person/ designation
Deputy Contact Person/ designation
Product
PS License Number
Verification of Product Identification
File (pls give details of change, if
any)
Date of Issuance of Original License

:
:
:
:
:
:
:
:
:

:

Previous factory and product audit

Initial

Surveillance

Extension

Product

Recommended for audit

Special 

Surveillance Extension Product Special

Date of audit

:

Recommended date of audit:

Date of follow-up

:

Recommended Team Leader

Auditors

:

Team Member :

Factory audit
Certified by PAO accredited CB?

Yes

Elements

Product audit

2008

Minor/Major

Factory audit

Please submit photo
copy of QMS Certificate
including scope of
certification by CB

In-plant test:

2000

Product Auditor :

Product Standard:

No

Name of CB:

QMS used:

:








complete IMTE based on IG

2000 QMS 2008 QMS

all IMTE calibrated

Please audit elements:

Product audit
Conduct In-plant test and
Check the ff:

completeness of IMTE
based on IG

calibration of IMTE
Knowledge, training &

competent QA/QC staff
in-plant test complied/ TR

competence of QA/QC

samples drawn for independent test

staff based on PNS

conduct in-plant test
submit in-plant test

Remarks:

report

draw samples for
independent test

verify use of certification

Independent Laboratory test
Name of test laboratory:

mark

Remarks:

Result of test
Remarks:
Re-test:

Prepared by:

Noted by:

F
O
R
M

No.
Revision No.

SD-A05-QF16
4

Effectivity Date:
Page

23 Dec. 2011
1 of 1