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Verification & Validation RDR-XXXXX

Document Name Test Report


Month, 20YY Page 1 of 5 pages Revision 01

Before Use - Verify that


This is the Last Released revision of this Document

Document Name Test Report

Signature Date Title Name


Written By
Reviewed By
Approved By

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Verification & Validation RDR-XXXXX
Document Name Test Report
Month, 20YY Page 2 of 5 pages Revision 01

Revision History

Revision Ref # Change Rationale & Description Date Signature


01 - First Issue

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Verification & Validation RDR-XXXXX
Document Name Test Report
Month, 20YY Page 3 of 5 pages Revision 01

1. Introduction
1.1. ...

2. Scope
2.1. …

3. Purpose
3.1. ...

4. Definitions
4.1. …

5. Referenced documents
5.1. ...

6. Responsibility
6.1. …

7. Test type, environment and site


7.1. ...

8. Acceptance criteria
8.1. …

9. Sample size / sampling plan


9.1. …

10. Method
10.1. ...
10.1.1.

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Verification & Validation RDR-XXXXX
Document Name Test Report
Month, 20YY Page 4 of 5 pages Revision 01

11. Materials & equipment


11.1. …

12. Procedure
12.1. …

13. Test records


The following test records shall be maintained and retained as part of the DHF:
13.1. All test records (filled form) will be kept on file as a quality record
13.2. Route cards for manufactured units
13.3. Sterilization records
13.4. Any additional relevant information
13.5. XXX
13.6. XXX

14. Results & analysis


Test records shall include:
14.1. Test equipment identification
14.2. Sample tractability
14.3. Test data
14.4. Statistical analysis
14.5. Identification of the person performing the test
14.6. Protocol deviations if needed
14.7. XXX
14.8. XXX

15. Revalidation / requalification


15.1. …

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Verification & Validation RDR-XXXXX
Document Name Test Report
Month, 20YY Page 5 of 5 pages Revision 01

16. List of Appendixes

Confidential

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