FOR OFFICIAL USE ONLY

CORRECTIVE ACTION REVIEW /

AUDIT CLOSE-OUT FORM
Form: FM_MQL24

To be completed by the AUDITOR and submitted to the MANUFACTURER and the APVMA, within 10 days of receipt of Corrective Actions submitted for Desk Review or date of Verification Audit.

Email: Post: Fax:

MLS@apvma.gov.au APVMA (02) 6210 4813
PO Box 6182
KINGSTON ACT 2604

1. Name and street 2. Licence /

address Reference
of Manufacturer No.
audited.
3. Date/s of original 4. Review Desk Review  Date: ………..
audit. Type
Verification Audit  Date: ………..

5. Corrective Action Review:

NC No. Evidence Reviewed Date Rec’d Satisfactory If, “No”, Due

from Manuf. (Yes/No) Date for Re-
(from Section (please specify document numbers etc, attach copy of
(desk review Submission /
C of Audit corrective action plan, if applicable)
submissions) Re-Audit
Report)

6. Comments:

7. Close-Out: ALL non-conformances have been satisfactorily addressed YES  NO 

8. APVMA  Has been or will be returned to the APVMA

Information
(please tick)  Has been or will be destroyed securely
 I wish to retain the information and it will be stored securely.
Auditor’s Name: .....................................................................
Signature: .................................................................... Date: .......................................

FOR OFFICIAL USE ONLY

FM_MQL24 Page 1 of 1 Version 1 Issued: 1 July 2014