Title Page

  • Site conducted

  • Starting Date

  • End Date

  • Prepared by

  • Line

  • Allergen Containing Product Recipe

  • Non Allergen Containing Product Recipe

  • External Laboratory Used

  • Internal Swab Kit Used

  • Lot Number

  • Expiration date of the kit

Results Summary

    Swab Point
  • Swab Point Reference Number

  • Swab Point Name

  • Pre Clean Internal Result

  • Pre Clean External Result

  • Post Clean Internal Result

  • Post Clean External Result

Product Results

  • Allergen Product Result

  • Non Allergen Product Result 1

  • Non Allergen Product Result 2

  • Non Allergen Product Result 3

Validation Summary

  • Have all clean swabs internally and internally passed?

  • Any further comments regarding the validation:

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