Name of RO

SAP no Date of Inspection

Dist Location
SO DO

Product DU-Make DU Sr No DU- Model DU Logs Logs validated through Deviation In case Yes, Details of action
(1. Calibration K Factor changes relevant documents/ Observed taken
2. OTP OEM service reports etc Yes/No
usage Instance 3.
Hardware change 4.
Firmware Change 5.
Error Log Etc)

Note 1. In case of any deviation observed, RO to be inspected as per std. format and action to be taken as per MDG
2. Printout of DU logs and other relevant documents duly signed by inpecting officer & RO representative to be enclosed

Signature of Inspecting officer Sign of Dealer/ Representative

Name Name
Designation