UFC 4-390-01
23 July 2003
CARD NO.:
________________
SER #:
________________
SYSTEM CERTIFICATION SURVEY CARD
ORGANIZATION:
SYSTEM:
ITEM:
CATEGORY OF DEFICIENCY:
TEAM MEMBER:
SURVEY DATE:
___________
(A) FINDINGS:
(B) RECOMMENDATIONS:
(C) DATE CORRECTIVE ACTION MUST BE COMPLETED:
(D) CORRECTIVE ACTION:
(E) VERIFICATION OF CORRECTIVE ACTION:
I have reviewed the
Corrective Action and
consider it to fully
correct the Findings
_______________________________
_______________________
SENIOR SYSTEM REP
DATE
POSITION
(F) CORRECTIVE ACTION IS SATISFACTORY:
____________________________
_____________________________
SCA TEAM MEMBER
DATE
NAVFAC OOCE
DATE
Figure 4
Sample System Certification Survey Card
20
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