AC/VETR/003

Report No.:
Sheet 1 of 1
VISUAL EXAMINATION TEST
Date :
REPORT
Item :
Reference Drawing :
Reference Standard :
Description :

Visual Examination on :

Final DFT Check:

1 2 3 4 5 6 7 8 9 10 Avg.

Remarks :

Judgment: Acceptable Not Acceptable

AYTB/CLIENT COMPANY
ACORTEC
REPRESENTATIVE REPRESENTATIVE
QA/QC
QA/QC QA/QC
Name
Signature
Date

Distribution to : ____________________________________________________________