Raw Material Sampling Record






Company Name:-

Quality Assurance Department


Raw Material Sampling Record


Revision No.:- 
Issue Date:-


Material: ___________________________________GRN #: ______________________
Batch / Lot # :___________________________         Batch / Lot Size: ______________
QA    # : __________________________    No. of Units: ______________________

Physical Inspection by Q.A.

Supplier Name: ___________________________________________________________
Manufacturer / Supplier: ____________________________________________________
Product code: _______________________________Ref. # : _______________________

Mode of Packaging / Status

Description
Card Board Box
Card Board Drum
Plastic Drum
Paper Bag
Cotton Bag
Steel Drum
Aluminium Container
Damage







Satisfactory







Dirty







Polythene Bag







Extra Packing







Identification








     No. of Sample Taken: ______________________________

Units No. from where sample taken:

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100

Weight of each Sample Taken: ______________________________

Remarks: _______________________________________________________________
_______________________________________________________________________
_______________________________________________________________________


Sampled by: (Q.A. Officer)(Sign) ______________________     (Date) __________


Reviewed & Approved by: (Q.A. Manager) (Sign)___________________(Date) _________

Prepared By:


QA Officer
Reviewed By:


QA Manager
Authorized By:


Director



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