Technical Exhibit T - TMDE Inspection Template.pdf

To: Name - Calibration POC/Hand Receipt Holder

CC: Name

From: Name - CBC Calibration Coordinator

Re: Calibration Walk-Thru Review for HR# XXXXXXX, UIC# XXXXXX

Date: TBD

1. Purpose: To assist the CBC Equipment Manager in evaluating the efficient utilization of all assigned equipment, identify excess equipment, ensure calibration of equipment is current and maintained to minimize downtime, as evidenced by the appropriate label.

2. Location:

3. Date of Review:

4. Individuals Conducting Review:

a. Name - Calibration POC/Hand Receipt Holder

b. Name - CBC Calibration Coordinator

5. Review of:

Active – 0

CNR – 0

CBU – 0

CBO –0

Commercial – 0 On-site – X

6. After changes made on the IMRF and G-4 LOG DIV Database the customer has listed:

Active – 0

CNR – 0

CBU – 0

CBO – 0

Commercial – 0 On-site – X

7. The following equipment was inventoried under:

(if the comment column is blank, no discrepancies were present):

Nomenclature Barcode Serial # Comments

Any Discrepancy:

Action:

8. All equipment on hand being utilized: yes or no (?)

9. It is the customer’s responsibility to review the Quarterly Instrument Master Record File (IMRF) to verify that all equipment is in their possession is properly labeled. The Hand Receipt Holder has the option to change the status of their equipment (e.g. Active, CBU, CNR, CBO) to accommodate specific needs. As soon as annotated reports are received, we will provide appropriate labels. For additional guidance, please reference TMDE Policy/Guidance provided. If you have any questions or concerns, please do not hesitate to contact our office.

10. If you have any questions or concerns, please do not hesitate to contact our office.