Please write Remarks in the blank after inspection

1)Water Fill testing to be carried out for bunding. As per GES 306.
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Detail of Material Used / Issued from Store:

S.no Item (Code / Description) Purpose of Usage

__ __________________________
_______________________________________________________

__ __________________________
_______________________________________________________

__ __________________________
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*Quality/EHS Assessment if Required After Maintenance (Answer in Yes/No) ______

*Maintenance has been done on product contact part (Yes/No) Complete Description :
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*Quality/EHS Critical parts were taken out of the clean area (Yes/No) Complete
Description: ________________

*GxP/EHS Spares or components has been replaced with ( ) identical ( )

Equivalent ( ) Substitute ( ) Redesign

*In case of Any Spare part or component with "Replacement" or "Redesign"

*Change Control Number: Validation Review is Required: (YES/NO)

*Calibration is required after maintenance: ( ) YES ( ) NO

House Keeping/Cleaning performed ( ) YES ( ) NO

Signatories & Comments

Equipment Handed over by(Engg)Sign/Date: Comments:

Equipment Handed over to (user)Sign/Date: Comments:

Approved By (QA Authorized Person)Sign/Date: Comments:

(For Quality critical Maint. Only)

Approved By (EHS Authorized Person)Sign/Date: Comments:

(For EHS critical Maint. Only)