| Product Name: | |
| Model/Part Number: | |
| Batch / Lot Number: | |
| Inspection Date: | |
| Inspected By: |
| Item | Criteria/Standard | Pass | Fail | Remarks |
|---|---|---|---|---|
| Packaging Integrity | ||||
| Labeling Accuracy | ||||
| Product Appearance | ||||
| Functionality Test | ||||
| Sterilization Status | ||||
| Documentation Included | ||||
| Other |
| Accepted | Rejected |