Report No.:
Date:
Supplier Name:
Material Name:
Material Code:
Batch/Lot No.:
Received Quantity:
Unit:

Sample Size:
Inspection Date:
Inspected By:

Inspection Parameter	Specification	Observation	Result
			Pass Fail
			Pass Fail
			Pass Fail

Remarks:

Disposition: Accepted Rejected Conditional
Inspected By (Signature):
Date:
Approved By:
Date: