You are on page 1of 1

Resource Manual

 Clearly identify swab point or product by indicating room, machine


and location.
G.2 - Allergen Validation Record  Under Pass / Fail, mark with P if it passes test, or F if it fails test.

Sampled by: _________________________________________ Date: _________________________________________


Tested by: ___________________________________________ Date: _________________________________________
Results read by: ______________________________________ Date: _________________________________________

Allergen of Concern Swab Point or Test Performed Result (+/-) Corrective actions
Product

Re-Test Results

Swab point Re-test Re-test Result Pass/Fail Corrective Action


Performed

On-site verification done by: Date: Deviations/comments:

Record verification done by: Date: Deviations/Comments:

__________________________________________________________________________________________________________________________
Allergen Program: Allergen Validation Record Page 1 of 1

Issue Date: _______________________

Developed by: ________________________________ Date last revised: _____________________________________________

Authorized by: ________________________________ Date authorized: ______________________________________________

You might also like