Visual Inspection for Final Product

Form No.: WI-22-03 Issue No.: 01

Product Name: Breathing Circuit with water trap Product Code: ………………….
Production/Inspection Date: 23 Nov.2021 Produced QTY:84
Production Order No.: 22-11-2021/19 Sample Size (WI-03): 2
Lot No.: B.C.W.T.421-Nov. Test Method: refer to WI-22
Apparatus used and their codes if any: ……………………………………………
N = No. of Conforming Samples, NC = No. of Non Conforming Samples, NA: for non applicable
specifications
N/NC for each Shipping Carton
Specifications Remarks
1 2 3 4 5
Labelling information N=2
No contamination N=2
No damage N=2
No blockage N=2
Shape N=2
Color N=2
Smooth surface N/A
N/A
Data printed on component N/A
Shiny appearance N/A
10. Sharp pointed tip N/A
11. No missing parts N=2
12. No mix-up N=2
13. Packaging stages N=2
14. Others N/A
Additional Comments: N/A
Conclusion: The Produced Lot is Accepted ( √ ) Rejected ( )

Tested by Checked by Approved by

:Title QC Specialist/Technician QC Supervisor QC Manager
:Date
Sig./
:Initial

This copy is confidential for GHATWARY MEDICAL GMS only Page: 1-1