AUDIT REPORT Report No.

Page of
Company Name: PT
Type of audit:
[ ] Procedure Testing
Address: [ ] Pre-Assessment

Name of Auditor(s): Copies of report

circulated to:
[ ] Auditee Company
[ ] Lead Auditor
Date(s) of Audit: 21, 23, 24 [ ] Audit Team
July 09

Area/Location being audited:

Documents Audit conducted against:

[ ] ISO 9001:2008 [ V ] ISO 14001:2004 [ V ] OHSAS 18001:2007
[ ] Other (specify): ___________________ [ ] Integrated (specify): ______________________

Documented System Reference:

Names of key personnel seen Job Title
1. MR
2. Doc Controller
3. HRD/GA Mgr
4. Warehouse
5. Warehouse
6. RD Mgr

Purpose of Audit:

Conclusion:

Signed ............................................................. Signed ..........................................................

Lead Auditor Company Representative
Date .........................................................… Date ...............................................................
Note:
1. This audit is based on a limited sample and other nonconformities may exist.
2. This report and its contents should be treated as confidential except with the prior
agreement of the company.