Ameya Clinic

DAILY OBSERVATION
A Unit of Vartak Health Services Pvt Ltd

Violation Description

Class of Violation □ Major □ Minor

Root Cause Of Violation

Suggestion /
Recommendation By
Observer

Name:_________________ Date ______________ Sign _______________

Following Region Shall Be Filled Up by Department Head / Designee Only
□ Accepted □ Rejected
Concerned Department Reason if Rejected:
Head / Designee
Comment

Name:_________________ Date ______________ Sign _______________

Correction / Immediate
Action

Version SRKH/001 Document Number SRKH/SOP/DPT/001

Effective Date 4 Sept 2018 Revision Date 3 Sept 2018
 Ameya Clinic
DAILY OBSERVATION
A Unit of Vartak Health Services Pvt Ltd

Corrective Action with

Timeline and
Responsible Personnel
Name

Preventive Action with

Timeline and
responsible Personnel
Name

By Personnel
Date Comment
(Sign / Date)

Comment By Concerned
Committee Incharge

Version SRKH/001 Document Number SRKH/SOP/DPT/001

Effective Date 4 Sept 2018 Revision Date 3 Sept 2018