Appendix I: Example Inspection Report Form

DOE-STD-1072-94

(Inspection Coordinator)

TO:

(Inspector)

FROM:

SUBJECT:

Inspection Report

. During this tour I noted the

, I made a tour of zone

(Number)

(Date)

deficiencies/conditions listed on the attached pages.

(Signature / Date)

TO:

(Responsible Manager)

FROM:

(Inspection Coordinator)

SUBJECT:

Inspection Report

Forwarded for action for each item as indicated.

(Signature / Date)

TO:

(Inspection Coordinator)

FROM:

(Responsible Manager)

SUBJECT:

Inspection Report

Corrective action for each item assigned to me has been completed as noted on the attached

pages.

(Signature / Date)

I-2