PROTOCOL DEVIATION REPORT

Protocol Number: 12345

Deviation Number: 1

Test Case & Test Step # 1, Step 10

1. DISCREPANCY
Description
This is a sample deviation report generated by FastVal. This report was generated to show an example of a
sample deviation report.

2. CAUSE INVESTIGATION RESULTS

N/A

This was a sample deviation report. There was no actual deviation.

3. RESOLUTION:

Corrective Action

Justification

N/A

No corrective action is required.

4. CONCLUSION (Impact to the protocol)

N/A

No further actions are required.

5. SIGNATURES
Print Name
Author
System Owner
Quality /Validation

Signature

Date