State Contract Monthly Feed Establishment Report FORM FDA-2684a PSC Graphics

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Specifications	State Contract Monthly Feed Establishment Report FORM FDA-2684a PSC Graphics
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CONTRACT NUMBERSTATE CONTRACT MONTHLY FEED ESTABLISHMENT REPORT NAMEDATE INSTRUCTIONS STATE AND AGENCY REPORTING PERIOD Follo

Specifications	State Contract Monthly Feed Establishment Report FORM FDA-2684a PSC Graphics
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Content	CONTRACT NUMBERSTATE CONTRACT MONTHLY FEED ESTABLISHMENT REPORT NAMEDATE INSTRUCTIONS STATE AND AGENCY REPORTING PERIOD Follow detailed instructions on back of this page. Reports are due on the last working day of the following month. Negative reports are required.PREPARED BY: b. ROUTINE INSPECTIONS c. REINSPECTIONS (Follow-ups to violative inspections) d. VISITS (Out-of-Business, etc.) a. TOTAL SAMPLES COLLECTED b. NUMBER EXAMINED c. NUMBER OF DETERMINATIONS 1. INSPECTIONS ACCOMPLISHED 2. SAMPLES (1) IN COMPLIANCE d. CLASSIFICATION (2) NOT IN COMPLIANCE a. WARNING LETTERS b. EMBARGOES/SEIZURES c. HEARINGS CONDUCTED d. PROSECUTIONS/INJUNCTIONS e. OTHER ACTIONS (Specify type) 3. COMPLIANCE ACTIONS 4. HIGHLIGHTS AND PROBLEMS ENCOUNTERED. On an attached sheet of paper, write a brief narrative detailing any major actions occurring, corrections achieved, problems with contract operations, work, etc. FORM FDA 2684a (4/11)PREVIOUS EDITION IS OBSOLETE a. TOTAL INSPECTIONS PSC Graphics (301) 443-1090 EF
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