Register Maintained By (QA/QC Inspector)
Name / Sign / Date
Inspector Signature
Name / Sign / Date
Reviewed By (QA/QC Manager)
Name / Sign / Date
Manager Signature
Name / Sign / Date
Total Samples Collected in Period
Name / Sign / Date
Total Samples Passed
Name / Sign / Date
Total Samples Failed/NC
Name / Sign / Date
Pass Rate (%)
Name / Sign / Date