Title Page
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Conducted on
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Prepared by
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CTS QSR Report No.
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Code XXXX-XX-CTSC-38RS-XXXX_XX
Surveillance Information
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DAILY REPORTS: SEG. 5 KENNEDY STATION
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Date of Visit
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Site Contact
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Contractor
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CTSC Package #
Inspection Scope/Observations/Results (1)
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Contractor
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(Describe the type of inspection, the work been inspected and list reference documents)
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(detail the observations and any recorded measurement, include photos)
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Add media
Inspection Scope/Observations/Results (2)
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Contractor
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(Describe the type of inspection, the work been inspected and list reference documents)
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(detail the observations and any recorded measurement, include photos)
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Add media
Inspection Scope/Observations/Results (3):
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Contractor
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(Describe the type of inspection, the work been inspected and list reference documents)
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(detail the observations and any recorded measurement, include photos)
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Add media
Inspection Scope/Observations/Results (4):
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Contractor
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(Describe the type of inspection, the work been inspected and list reference documents)
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(detail the observations and any recorded measurement, include photos)
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Add media
Inspection Scope/Observations/Results (5):
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Contractor
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(Describe the type of inspection, the work been inspected and list reference documents)
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(detail the observations and any recorded measurement, include photos)
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Add media
Deficiencies:
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(Detail any deficiencies identified)
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Follow-Up Actions:
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(Detail any actions required)
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Add media
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Inspected by: (Title)
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Reviewed by: (Title)
