Professional Regulation Commission

INSPECTION AND MONITORING REPORT

Board of _______________

EXECUTIVE SUMMARY

During the period __________________________, the undersigned conducted an inspection

and monitoring review of________________________________ in accordance with the
monitoring and inspection provisions of the _______________________ and approved work
program (RACIM No. ______).

Upon completion of the inspection and review, the following were the team’s findings,
observations and recommendations:

FINDINGS/OBSERVATIONS RECOMMENDATIONS / AGREED COMPLETION

PROPOSED CORRECTIVE DATE
ACTIONS

The monitoring team concludes that <include a statement as to whether there was compliance
or non-compliance with stated policies and procedures and results of the visit and inspection>.

Submitted by:

<Team Member Name>

<Position/Designation > Signature

<Team Member Name>

<Position/Designation> Signature

<Team Member Name>

<Position/Designation> Signature

<date of submission>

CONFORME:

<Signatory>
<Position/Designation>
<Name of Firm/Establishment/Organization>

ACD-IAM-03
Rev. 00
July 16, 2021
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