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Surveillance Audit Form
DTI BPS form for surveillance audit form
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Revision No.
SD-A05-QF16
4
Effectivity Date:
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23 Dec. 2011
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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
