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INSTALLATION QUALIFICATION PROTOCOL

Make ULTRA LOW DEEP FREEZER Area Of Test
Equipment

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INSTALLATION QUALIFICATION
OF

ULTRA LOW DEEP FREEZER

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INSTALLATION QUALIFICATION PROTOCOL

Make ULTRA LOW DEEP FREEZER Area Of Test
Equipment

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INDEX

SR. NO. DESCRIPTION PAGE NO.

1.0 PROTOCOL APPROVAL 03

2.0 QUALIFICATION TEAM 04

3.0 PURPOSE, DEFINITION AND SCOPE OF IQ 05

4.0 EQUIPMENT VERIFICATION 06

5.0 SUPPORTING UTILITIES 07

6.0 SAFETY VERIFICATION 08

7.0 REFERENCE DOCUMENTS 09

8.0 INSTALATION QUALIFICATION REPORT 10

9.0 CERTIFICATION 11

10.0 REPORT APPROVAL 11

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INSTALLATION QUALIFICATION PROTOCOL

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1.0) PROTOCOL APPROVAL

Installation Qualification of the Make Equipment, Model No: ,

Sr. No: _________________________________has been reviewed and approved by the following
personnel.

Done By:
Company:
Name:
Designation:
Signature:
Date:

Approved By:
Company:
Name:
Designation:
Signature:
Date:
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INSTALLATION QUALIFICATION PROTOCOL

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2.0) QUALIFICATION TEAM.

The following team will be responsible for the execution of Installation Qualification protocol.

Sr. No. Name Department Designation Signature

Done By: Checked By:

Name: Name:
Signature & Date: Signature & Date:
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INSTALLATION QUALIFICATION PROTOCOL

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3.0) PURPOSE, DEFINITION AND SCOPE OF IQ.

This Installation Qualification Protocol is intended to be applied only on those instruments which are
new. The following protocol has been written in order to help the user validate pre-defined
specifications within a specific environment. The protocol begins with inspection of the premises,
supporting utilities and equipment.

This document must not be treated as a substitute of the user manual. The contents of the user
manual are essential for the completion of this IQ. Please obtain a new copy of the user manual from
.

General Definition:

Installation Qualification (IQ) verifies that the equipment is installed according to the manufacturer's
recommendation. It covers such areas as operating conditions, physical connections and system
configuration.

RECOMMENDATION

The Installation Qualification (IQ) is carried out under the following conditions:

1 The ULTRA LOW DEEP FREEZER has been installed for the first time.

Done By: Checked By:

Name: Name:
Signature & Date: Signature & Date:
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INSTALLATION QUALIFICATION PROTOCOL

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4.0) EQUIPMENT VERIFICATION

The details of the ULTRA LOW DEEP FREEZER used for qualification include.

Sr Acceptance Variance Done by

Parameter As built
No Criteria Remarks

1 Make

2 Model

3 Serial No.

ULTRA LOW DEEP

4 Type FREEZER

5 WEIGHT 359 Kg ± 5 Kg

Comments:

Done By: Checked By:

Name: Name:
Signature & Date: Signature & Date:
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INSTALLATION QUALIFICATION PROTOCOL

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5.0) SUPPORTING UTILITIES:

Following are the utilities required to operate the system to be arranged by the customer at site.
Sr. Type of Utility Acceptance As Variance Done by
No. criteria recommended

Voltage: 220-240V
Electrical Power Phase: 1 Phase
01 Specifications Frequency: 50 Hz

Ambient 25 0C +20C
02 conditions

Comments:

Done By: Checked By:

Name: Name:
Signature & Date: Signature & Date:
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INSTALLATION QUALIFICATION PROTOCOL
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6.0) SAFETY VERIFICATION:

Sr.
Parameter Acceptance criteria As built Variance Done by
No.

Earthing must be
1 Earthing provided to the

There should not be

Check the Freezer
2 any sharp edges on
for any sharp edges
the Freezer.

Done By: Checked By:

Name: Name:
Signature & Date: Signature & Date:
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INSTALLATION QUALIFICATION PROTOCOL
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7.0) REFERENCE DOCUMENTS ACCESSORIES

To check the documents required for the job as per the check list below.

List of reference documents Accessories

Sr. No. Title of document Remarks

1 Operation Manual
2 Door Keys
3 USBPen Drive
4 Spanner

Acceptance Criteria: The documents submitted shall be as specified in the list of reference
documents.

Comments:

Done By: Checked By:

Name: Name:
Signature & Date: Signature & Date:
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INSTALLATION QUALIFICATION PROTOCOL
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8.0) INSTALLATION QUALIFICATION REPORT:

RESULTS

CONCLUSIONS:

Done By: Checked By:

Name: Name:
Signature & Date: Signature & Date:
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9.0) CERTIFICATION

The equipment Installation Qualification for Make ULTRA LOW DEEP FREEZER Model No.:
equipment Sr. no.______________________________ have been examined
and found to be acceptable. All the parameters mentioned in IQ are reviewed & found satisfactory.

10.0) INSTALLATION QUALIFICATION APPROVAL REPORT:

The equipment Installation Qualification for make ULTRA LOW DEEP FREEZER Model No.:
equipment Sr. no.______________________________ have been examined
and found to be acceptable. Report Prepared, reviewed and approved by following authority.

Preparation And Reviewed

Name Designation Signature

Preparation

Reviewed – Engineering

Reviewed By-

Approved By-