Company Name_________
Quality Assurance Department
Line Clearance Certificate

Issue Date:   Revision No.

Section:_______________________                      Area / Stage: ____________________

Product:_______________________                      Batch No. : ______________________

QA#: _________________________                      Date/Time: _______________________
General Cleanliness

Floor:                                Windows:                               Walls:                           Ceiling:

Packing Belt:                  Containers:                            Uniform:                       Dust Bin:

Ensure that there should not be any remnant of previous product/batch

Previous Product: ___________________            Batch No. : _____________________

Completion Date: ___________________           Completion Time: _________________

 Batch Documents:                             Ampoules:                                    Labels:

     Vials:                                                  Cartons:                                          Tablets:

        Leaflet:                                              Capsules:                                         Shippers:

            Printed Al. Foil:                   Bulk Material:                             Alu-Alu / PVC Foil

Capsule/Tablets Blisters               Bottles:                             Empty Capsule Shells:

Released Slip:                                Caps:
Satisfactory           ( P )
                                                                                                                               Not Satisfactory    (X)
                                                                                                                                Not Applicable      ( -- )

Certified that above mentioned items are checked & found
Satisfactory/ Not Satisfactory and Area/ Line is Approved / Not Approved           to start the operation.

Checked By:  ___________________

Prepared By:

QA Officer
Reviewed By:

QA Manager
Authorized By: