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Annex 4 Supplementary guidelines on good manufacturing practices

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Format for an installati<strong>on</strong> qualifi cati<strong>on</strong> protocol and report a<br />

Validati<strong>on</strong> protocol _________ Installati<strong>on</strong> Qualifi cati<strong>on</strong> _________ Page _____ of _____<br />

Title: ______________ Name and address of site: ________________________________<br />

________________________________________________________________________________<br />

Validati<strong>on</strong> Protocol # __________________________________ IQ Protocol number: ______<br />

Title: ___________________________________________________________________________<br />

Protocol written by: _________________________________<br />

Protocol approved by: ______________________________ Date: _____________________<br />

QA Approval: ______________________________________ Date: _____________________<br />

Objective<br />

To ensure that _________________ (system/equipment) installed c<strong>on</strong>forms to the purchase<br />

specifi cati<strong>on</strong>s and the manufacturer details and literature, and to document the<br />

informati<strong>on</strong> that ________________________ (system/equipment) meets its specifi cati<strong>on</strong>s.<br />

Equipment inventory number: _____________________________________________________<br />

Scope<br />

To perform installati<strong>on</strong> qualifi cati<strong>on</strong> as described in this IQ protocol at the time of<br />

installati<strong>on</strong>, modifi cati<strong>on</strong> and relocati<strong>on</strong>.<br />

Resp<strong>on</strong>sibility<br />

___________________ (post/pers<strong>on</strong>) overseeing the installati<strong>on</strong> will perform the qualifi cati<strong>on</strong><br />

and records results.<br />

___________________ (post/pers<strong>on</strong>) will verify results and write the report.<br />

Quality Assurance will review and approve the IQ protocol and report.<br />

a This format is used for training purposes and refl ects some of the possible c<strong>on</strong>tents for an installati<strong>on</strong> qualifi cati<strong>on</strong><br />

protocol.<br />

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