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Name
Company
Date
Facility Information
Facility Name
Address
Phone
Facility Type
Regulatory Status
Personnel
Responsible Person
Qualified Person
Trained Staff
Quality Management System
Quality Manual Available
Change Control Procedures
Deviations Documented
Corrective and Preventive Actions
Facility and Equipment
Appropriate Facility Design
Suitable Equipment Calibration
Preventative Maintenance Program
Documentation and Records
SOPs Available
Documentation Controlled
Batch Records Complete
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Inspector Name
Inspector Signature
Date