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CM/PF/PDWJAN 2005
BUREAU OF INDIAN STANDARDS
REPORT OF PERIODIC INSPECTION
(Put
√
mark on appropriate nature of inspection)( ___________ inspection since Grant of Licence/Renewal)
CM/L-No ________________ IR No. ________________________Valid upto _______________ Date of writing IR _______________1. a)
Licensee
b)
IS 14543:2004 Packaged Drinking Water ( Other Than Packaged Natural Mineral Water)Type, Material and capacity of containers coveredUnder licence
 c)
Other licence(s) held CM/L-No IS Product2. Special inspection charges, if applicable with details of realization3. Date of inspection4. Person(s) contacted5. Change in Management , if any6. Previous inspection details
a) Date and conducted byb) Conclusions and recommendationsc) Details of last two factory samples
SlNoDate of drawal of sampleMode and date of despatchStatus of sample(Whether report received)Pass/Fail(if applicable)7. Action on advice rendered in previous inspection orotherwise asked for while granting licence/renewal of the licenceREMARKS OF THE REVIEWING OFFICER ON PERFORMANCE OF LICENSEE KEEPING IN VIEWTHE PAST PERFORMANCE ( ON IRs, TRs, GENERAL, etc.) WITH SIGNATURE AND DATE
1.2.3.4,
Signature of the Reviewing Officer  Designation Date
 
 
CM/L-No.
8. Source of raw water
a) Own Borewell/Municipality/Other Supply(specify)b) Whether source changed from declared earlierc) If yes, compliance to STId) Whether records of testing maintained as per STI
9. Packaging material
a) Details of receiptContainerType Material CapacityName of Supplier WhetherBIScertifiedWhetherreceivedwith testcertificateWhethertested in-houseJarBottleCupGlassPouchCapsb) Manner of disposal of sub-standard packaging materialc) Whether packing is done in approved container(s) ?If not, give detailsd) Whether records being maintained in accordance withSTI
10. Production details
a) Whether water being produced/packed at the time of inspection ?b) Whether any change in Process of Manufacturing andDisinfection from that declared earlier? If yes, givedetailsc) Production Controls Satisfactory/Unsatisfactoryd) Production and supply since last periodic inspection(enclose details of completed month)i) Quantity producedii) Quantity markediii) Quantity unmarked and manner of disposaliv) Reasons for not markingv) Parties supplied to ( Give complete address )
 
CM/L-No.
11.
Storing, Packing and Marking of BIS certifiedmaterial
a) Material held in stock b) Packing and marking on packagesc) At what stage marking is done(After or before test results are known)d) Any change in the marking procedure from approved onee) Compliance to Labeling Prohibitions12.
Testing arrangements and testing
a)
Details of change(s) in Testing Personnel, if anysince previous inspection.
 
b)
Competence of new Testing Personnel
 
c)
Are the frequencies of tests and records testing beingmaintained satisfactorily vis-à-vis the STI
 
d)
Variation in test result
 
Enclose Report in Annex 1
 
e)
Details of failure reported, if any and correctiveactions taken for the same
 
f)
Are all required instruments available and in workingorder? If No, give details
 
g)
Change/addition in testing facilities
 
h)
Details of calibration of Balance & Incubators
 
13.
Testing in factory
Description of the sample ( Type, Material, Capacityof Container and Batch No., Mfg. date)
Sl Requirements tested Value obtained Value recorded Remarks
of 00

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