| Device Name | |
|---|---|
| Model/Reference No. | |
| Manufacturer | |
| Date of Verification | |
| Verifier |
| Requirement | Present | Comments |
|---|---|---|
| Device name is clearly stated | ||
| Model or reference number is correct | ||
| Manufacturer name and address included | ||
| Country of manufacture | ||
| Lot or serial number | ||
| Manufacture date / expiry date | ||
| Intended use/Indications | ||
| Storage / handling instructions | ||
| Warnings or precautions included | ||
| Symbols, if applicable | ||
| UDI (Unique Device Identification), if applicable | ||
| Language(s) as required |