BRSM 
  Systems:QMS ISO 9001 (2008)‐FSMS ISO 22000 (2005) 

 
Assessment Report/Checklist 
Form 009 

 
CLIENT‐ORGANIZATION (NAME):    Roshan Mahdi Food Industry 

PHYSICAL LOCATION(s):   No. 1804, No. 6/1 Alley, 6th St., Khatam Rad St., 
Abbas Abad Industrial Town 
45th Km of Khavaran Road, Tehran, Iran 
Stage II Audit Date(s):    3,4 Jun 2016 

Stage I Audit Date(s):    7 May 2016 

NAICS (or NACE) CODE 10.85/CII 

EXCLUSIONS:    7‐3,7‐5‐2,7‐5-4(ISO 9001) 

 
Assessment objectives: Third party assessment , Attesting requirements 
of ISO 9001:2008,ISO 22000 :2005 in 
management system of the client company 
 
 
ASSESSMENT TEAM INFORMATION 
Assessment Team Leader, ATL Akbar Shams 
Assessor 2 Vahid Salahi 
 
 
 
Note: Adjusting the language within this form to the type of activity and nature of the organization is acceptable.
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We pursuit to assure that client‐organization adheres to the protection of communities and consumers. This is to 
1  follow the intent to the substitution of the word “identify” to the word “determine” as part of the importance to 
the processes being capable of achieving desired outputs (including consumer’s well‐being). 
Production and packaging of frozen vegetables mix the chopped leaves, frozen
vegetables other simple leaf, frozen vegetables chopped simple leaf, fried green leaf
2  Scope of activities  simple, vegetable salad, mixed fresh herbs, mixed chopped fresh herbs, non-leaf
fresh herbs, simple leaf fresh herbs, non-leafy vegetables chopped fresh

Legal status  FDA Iran

3 
Obligatory applicable standard which  ISIRI 5170-286-5583-5585-5168-5586-535-5589-10080-1053-1011-2198-3759-
organization has to follow  1810-2946-437-2461-997-356-622-1836-4976-2842 
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9001 22000
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Quality/ Food safety
4 4
management system
4.1 4.1 General requirements
the quality management system includes Manual,
procedures and work instructions as well as forms and
external instructions and standards if applicable
the documents of the company have been reviewed in
stage I one assessment and all mandatory procedures
have been in place,
Documentation requirements
General Nonconformity was removed.
Quality manual Quality Manual Documents are
4.2
4.2
4.2.1
Control of documents established/recommended by any member of the
4.2.1 Updating of preliminary organization, then the management representative
4.2.2
4.2.2
7.7
information and documents
reviews and approves it initially and with signature of A
4.2.3 specifying the PRPs and the
4.2.3 the management the document is valid to be used
4.2.4 HACCP plan
8.5.2
Control of records Control of documents and records addresses the
Updating the food safety document and record control; all records are subject to
management system
be kept up to 10 years after sale.
Records of Identification and risk management are keep
for 50 years
Last –step of HACCP: review of information and
documents related to PRP and plan HACCP has done
.No Need to revise
5 5 Management responsibility
Management commitment observed through checking
of the process within the company, such as resource
5.1 5.1 Management commitment A
provision, policy, management review meeting, and the
opening and closing meeting
Emergency Situation:
Emergency preparedness and
N/A 5.7
response
Shortage of Row Material in the market. A
The return of the consumer arena

FORM‐009_V4_QMS MDD                                     Issued: July 9, 2003                                                        Revised: March 2013                                                       Page 2 of 16 
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Spread of infection
Disruption of transportation fleet
Lack of water / water contamination
-Product contamination
-Collect all contaminated and suspected products from
warehouses and production lines and creating
conditions for quarantine
Collecting of distributed products in accordance
withdraw procedure
Testing and making decision how to deal with
contaminations
- Informing the authorities and destruction of infected
products
Investigating method and ways to eliminates and
removing contamination and take appropriate actions
-Food safety team includes technical Manager and
M.R(Ms. Moghadam),production Manager ,Sales
Manager, PM Manager ,
-Records of contamination drills on 94/11/24(Feb 2016)
was observed.

Records of customer survey such as

Frozen Vegetable, customer : Iran air Force Army ,date
11/3/95 (April 2016)
Frozen Vegetable, customer : Fallahi Market ,date 15/3/95
(April 2016)
5.2 Customer focus No records of Complaints.
7.2.3 5.6.1 External communication Records of IMOH visit from organizations on 94/12/20(March A
8.2.1 Customer satisfaction 2016) was observed.
PRP has been audited on April 2015, result is 810 from 1000.
This is acceptable in this sector.

 
Integrated policy food quality and safety is set. The most
important objectives in the policy include:
- Acquisition of customer satisfaction in order to increase
competitiveness in the market.
5.3 Quality/ Food safety policy - Establishing proper infrastructure and improve the
5.4.1 5.2 Quality/ Food safety objectives A
resources, equipment and technology organization
-Increase knowledge and awareness of personnel and
training specialists according to the needs of businesses and
organizations in the market. 
Producing various products with innovation
Informing policy to personnel were investigated. Ms.

FORM‐009_V4_QMS MDD                                     Issued: July 9, 2003                                                        Revised: March 2013                                                       Page 3 of 16 
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Fatemeh Alizadeh And Abbass was asked packaging is

appropriate personnel.
The retention of reviewing of policy is annual
The obligation to comply with legal requirements stated in
the policy. . 
Objective are Measurable for example Customer satisfaction
index is 90%,
Preventive form contamination index: final microbial test
must one product in the year. In last year no contamination
reported.

Integrated Management system planning

ISO9001ISO22000-HACCP has been done.
Planning General requirements have been established based on risk
5.4 levels. Systems has implemented For 6 month, and records
5.4.2
5.3 Quality/ Food safety A
management planning has been established and maintained for 6 month. Then the
documentation requirements were reviewed in Management
review. there was no need to revise

Management representative appointed Food safety leader

Management .official letter of 94/06/26 was observed. Food safety team
5.5.2 5.5 representative includes technical Manager and M.R(Ms.
Food safety team leader Moghadam),production Manager ,Sales Manager, PM
Manager.
Organizational chart was reviewed. 3 level hierarchy under
the management of Director has been determined..
Suggestion Box is installed in the organization.
5.6 Internal communication Winning Informing to the latest changes in laws and
5.5.3
5.6.2 Communication
regulations is installed in a place of rest.
Policies have been installed in different parts of the
organization.
Job descriptions and authorities for Production worker and
technical Manager were observed.
For example for production Worker:
job description such as:
. The realization of the objectives of the organization's
quality policy is in line with efforts
. efforts to produce quality products at the scheduled time
Responsibility, authority
and communication
. perform all responsibilities have been handed
Responsi . Clean your work area and the machine
5.5
bility and . Wear Uniforms
5.5.1 5.4 A
authority .comply with all health and safety issues
Internal
communic
ation
Qualifying Conditions production worker:
Secondary education, work experience 1 year
Training: personal hygiene –working by machine instruction
Skills: detect pollution

Some Example Duties Technical Manager:

1. The cooperation in the preparation of the technical

FORM‐009_V4_QMS MDD                                     Issued: July 9, 2003                                                        Revised: March 2013                                                       Page 4 of 16 
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information needed to perform the required,

-. supervision of All tests
-. Follow the calibration of all devices need to be calibrated
Examples Job Qualifications:
Bachelor degree on food industrial
At least 3 years relevant experience
Familiar with ISO 22000

Management review dated 2/20/95(May 2016)

Inputs were checked.
Out puts such as:
It was decided to continue the current trend in production
control; if possible preventive action is considered to prevent
5.6 5.8 Management review the failure of the products.
5.6.1 5.8.1 General review Data analysis and verification result:
5.6.2 5.8.2 Input Based on Identifying and evaluations hazards :28 hazards A
5.6.3 5.8.3 Out put identified 12 OPRP and 11 CCP and 5 CP
For all CCP and OPRP verification plan was considered.
For all CCP , specification form control of Critical point
(F07-P04)was observed...
Identified OPRP appropriate verification was considered.

6 6 Resource management
The appropriated resource were provided. Human resources
6.1 6.1 Provision of resources and equipment and working environment.

In last year(1394) 12 Course was conduct. such as Personnel

Hygiene ,ISO 22000 requirements,
The effectiveness of the courses was evaluated. The
evaluation records for production Supervisor was observed.
The evaluation Score was 83% which was acceptable
Human resources At least 11Hours of training per person was Considered I
6.2 6.2
General 1394, which objective has been achieved.
6.2.1 6.2.1
Competence, awareness and A
6.2.2 6.2.2 Courses that are planned in the first half of 95 are as follows:
training
methods of production and control characteristics associated
with the production (16/04/95)
Technical supervisor training records were for the safety
team manager were reviewed Qualifying is sent.

Manufacturing equipment have been designed, constructed,

properly established and placed for proper operation.
Infrastructure according to the requirements of the FDA.
Infrastructure PRP
6.3 Work environment table code
6.3 The overall work environment of company is decent
6.4
6.4 Prerequisite programs AR :LI1701
7.2 In accordance 7.2/7.2.2/7.2.3 ISO 22000
(PRPs) As sample following case were checked
Dropped ceiling was appropriated in production departments.
Positive air Flow in production unit.
Light has safety coverage..

FORM‐009_V4_QMS MDD                                     Issued: July 9, 2003                                                        Revised: March 2013                                                       Page 5 of 16 
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Window meshes are appropriated.

Metal Pallet in storage
Production floors are washable.
The floor is corrosion resistant
Wall and floor edge are round
Production Entrance doors have not jack
The temporary refrigerator were checked..

-Raw material storage was observed. Classifications

separation of raw materials has been done. Is wedge-shaped
corner wall. Raw material storage is washable..
Health Card of 2 production staff was observed, health
examination has done based on the plan

Maintenance program (in accordance with repair and

maintenance procedure) of Onion Chopper machine on
March 2016 was observed. Cleaning Blades of machine is
Daily
MOH PRP audit has been conducted on Feb 2016
2 NC raised by moh auditors which was as below:
1- certificate is not extended yet
2-air conditioner need to be repair
Company raised two corrective action regarding the NCs
which is sent to MOH as below:
94-27: certificate extension request has been sent to MOH,
but, MOH needs audit PRP results for this issue, Audit is
postponed by MOH auditors for 6 weeks that is out of our
hands
94-28: we did not use fan system in winter, it will be repaired
on nouroz’s holiday.

7 7 Product realization
Production Lines:
1. Vegetable production lines:
It has 3 separate production lines include:
- Frozen Vegetable leaf
7.1 7.1 Planning of product realization
- Non-leafy frozen fried vegetables
A
- Fresh leafy vegetables
2. salad production line
3. onion production line

FORM‐009_V4_QMS MDD                                     Issued: July 9, 2003                                                        Revised: March 2013                                                       Page 6 of 16 
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Customer-related processes
Determination of Organization don’t have retail sale,
7.2 Most customers are Organizations
requirements related to
7.2.1 N/A
the product Air Force tender documents in March 2016 were checked. A
7.2.2
Review of requirements related There was no delay in delivery
to the product
Design and development Company manufactures in accordance with the MOH license
Design and development and because there is no change in ingredients and process
planning these clause is excluded.
Design and development
7.3 inputs
7.3.1
7.3.2 Design and development
7.3.3 outputs
7.3.4
N/A Design and development A
7.3.5 review
7.3.6 Design and development
7.3.7 verification
Design and development
validation
Control of design and
development changes

Onions Input controls: optical- good shapes- no insects and

,Weight
Purchasing
7.4 List of acceptable supplier includes 9 supplier was observed.
Purchasing process
7.4.1 Also filled out evaluation check list for supplier were
7.4.2
N/A Purchasing information A
Verification of purchased observed: Behpan Paksh(Disinfection) Grade A
7.4.3
product Phirooz Baspar provider of single use material score 80%
were observed... .

Production and service finished products refrigerator:

provision - The vegetable soup product was investigated., production
7.5 Control of production and date 01/09/94 ,Batch number SO-9-1
7.5.1 service provision
N/A - Coco vegetable production date 8/25/94 batch: KK8-7 A
7.5.2 Validation of production and
7.5.5 service provision ingredients :Chinese parsley , Chives , Dill
Identification Preservation of - Onions :production Date 24/12/94 batch: ON12-7
product - Mint and Parsley production date 9/28/94 batch: MP9-2

FORM‐009_V4_QMS MDD                                     Issued: July 9, 2003                                                        Revised: March 2013                                                       Page 7 of 16 
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Ingredients: Parsley and Mint

-Ghorme Sabzi vegetables production date 11.11.94 batch:
GH11-9 Ingredients: Spinach, parsley- chives- Chinese
parsley
Records of Frozen soup vegetable
Date production : 23 / 3/95(May 2016)
- Expiration date :18 months after production date
- batch No: SO31
- Quantity: 2 Pack 5 kg
- ingredient : parsley and Chinese parsley
- Storage conditions: temperature -18 °
-Health license: 34/18718

Example:

. Is done through Bach No Traceability

Frozen soup vegetable
Date production : 23 / 3/95(May 2016)
Identification - Expiration date :18 months after production date
7.9
7.5.3
7.10.4
Traceability - batch No: SO31 A
withdrawals Operators was Mr. ghafori and Zeygham- also Qc and
purchase Material was traceable
Withdraw procedure where checked. Batch No is mentioned
in sale.
-Withdraw drill records conducted in 95/2/18 for Frozen
soup vegetable batch SO8-1 were observed.
-Semi products have statues labels.
External calibration is PISHGAMAN ANDAZE SHENASI
DAGHIGH Company: under the NACI credit license. Its
certification was observed.
All equipment have Label
PH METER:
SERIAL NUMBER: FJFF2175 MODEL: PHS-25CW
NUMBER OF CERTIFICATE: 9407965
DATE OF ISSUE: 24/5/1394
STANDARD: PH SIMULATOR&REFRENCE
SOLUTIONS-ISIRI 4125
Control of monitoring and Environment Condition :T:+23+_ 3 C
7.6 8.3
measuring devices Refrigerator thermometer
A
SERIAL NUMBER: 9408120
DATE: 15/5/1394
Incubator :
SERIAL NUMBER: 9408124
DATE: 15/5/1394
The error has been installed on the device
Setting : 25.6
By reading: 25.6

8 Measurement, analysis and

8
8.1 improvement Validation,

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8.2 verification and improvement of

the food safety management
system
Base on plan frequency is every six month.
External Audit has done on end of 14 April 2016(95/01/26) in
accordance ISO 22000:2005 and ISO 9001:2008 requirements
2 NC were found
As example :
Records of HACCP plan were not observed.
8.2.2 8.4.1 Internal audit Appropriate Action Plan were taken, A
Also 3 recommendation for improvements such as
Use of Statistical software for data analysis
Independency and impartiality were checked.
Internal Audit certification of 2 Auditors Mr Tohidi and Ms
Moghadam were checked.

eleventh step :planning of Verification and validation

The results of the water analysis conducted by Regulatory
(Health of work environment central Office)
Food safety management Workplace Health Center on 12/16/94
system verification - PH = 7.2
8.4
Analysis of results of - Free chlorine residual = 0.5
N/A 8.4.3
verification activities A
8.2 - Coliforms per 100 ml: 0
Validation of control measure
combinations - Escherichia coli per 100 ml: 0
- S. 100 ml: 0
Responsible of testing: Hashemi

According to the data analysis procedure monitoring

processes were observed. Organization collect, identify and
analyze appropriate data to demonstrate efficiency.
Monitoring and measurement
of processes , if score of customer satisfaction below than 75 or every
8.2.3 Evaluation of individual item be zero corrective action must be done. Score of
8.4
N/A
verification results customer satisfaction for was 79 . A
Analysis of data Supplier evaluation process after supplier evaluation for the
first time, 2 suppliers removed from the list. because of they
score was under acceptable define criteria.
Acceptable Deviation of Delivery is 3%,the result is 1.8%

The final product: Ghorme Sabzi vegetable

-raw material Chives
Sampling at 9:50 on 95/01/10(April 2016)
Monitoring and measurement Control items: ISIRI 10080
of product - Freezing: No frost
8.2.4 8.4.2 System for the monitoring of - Color Appearance: natural color
critical control points - Blight: No
- Dirt: up to 10%
-No Damages
The final product :Onion
Sampling at 9:20 on 95/01/30 Batch No ON01014 (April
2016)

FORM‐009_V4_QMS MDD                                     Issued: July 9, 2003                                                        Revised: March 2013                                                       Page 9 of 16 
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Coliform I SIRI 9263 limited Quantity :100

Escherichia ISIRI 2946 : 0
mold & Yeasts ISIRI 997:10000
Salmonella ISIRI 1810:00
Parasite egg ISIRI 10080:0

Final Product :Soup Vegetable

Coliform I SIRI 9263 :Negative

Escherichia Coli ISIRI 2946 : Negative
mold & Yeasts ISIRI 997:10
Salmonella ISIRI 1810:Negative
Enterococcus ISIRI 2946 : 10
Parasite egg ISIRI 10080: Negative
Quality Control Responsible: Margan Moghadam

Tenth step: take the necessary actions in case deviation from

Control of nonconforming of the Critical Crieteria: NO Case
product Records of nonconforming product were checked. Two cases
7.6.5
Actions when monitoring Control the appearance of raw materials and record, 3 cases
8.3 7.10
results exceed critical limits A
7.10.3 in the production line have been observed. For All this is to
Handling of potentially unsafe
products determine the corrective action.

2 project for improvement is in progress:

Buying and install shiring machine

Data Analysis procedure QM-19-03

2-incresing production line ,project started in 94/11/20.
17 NC in total were found related to Internal Audit, Data
Analysis, for all them corrective action were taken .for 14 of
Improvement
8.5 8.5 them effectiveness were check, for 3 of them root analysis
Continual improvement
8.5.1 8.5.1 and effectiveness has not done.
8.5.2 7.10.2
Corrective action AR
Preventive action 94-27: certificate extension request has been sent to MOH,
8.5.3 7.10.1
corrections but, MOH needs audit PRP results for this issue, Audit is
postponed by MOH auditors for 6 weeks that is out of our
hands
94-28: we did not use fan system in winter, it will be repaired
on nouroz’s holiday.

   

FORM‐009_V4_QMS MDD                                     Issued: July 9, 2003                                                        Revised: March 2013                                                       Page 10 of 16 
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The first step: forming the food safety team: Ms. A

Moghadm- Mr. Tohidi- Mr Ghorbani

Second step :Product specifications

Product Description
Non-leaf fresh vegatbale
- Human consumer groups: All
- Limit consumption: none
- Ingredients: sweet pepper, corn, green peas –potato
bean-squash-bean-tomato- onion and etc.
- Important physical characteristics: smell and taste- dirt
- color uniformity – size uniformity
- Chemical characteristics: residual pesticides and
fungicides , metal pollution
- Microbiology characteristics: Coliform, Escherichia
Coli ,mold & Yeasts , Salmonella , Enterococcus , 
Parasite egg ,
- Storage time: 5 days at 3-2 ° C
- Packaging: polyethylene bag
- Transportation: Car refrigerator
- National standards: 5170-286-5583-5585-5168-5586-
535-5589-10080-1053-1011-2198-3759-1810-2946-437-
2461-997-356-622-1836-4976-2842

Preliminary steps to enable Description Ingredients(Raw Material):

N/A 7.3
hazard analysis Fresh green leaf
- Physical specification: smell and taste- dirt - uniformity
of color-uniformity of size
- -
Method of production: The crop of vegetables in farms
or greenhouses
- Packaging: Polyethylene bags 40-10 kg weight
category 2-5 / 1 kg

Step Four: OPC

Onion production line:
Date of manufacture 95/02/01(April 2016)
Expiration date: 18 months after production
Batch No: ON.2.1
Package weight: 10 kg.
Ingredients: Onions
Storage conditions: temperature -18 °
Health permits: 34/18755
Onion processing steps:
1. The temporary freezing of raw materials
2. Transfer
3. control and chopping
4. Transfer
5. washing with water

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6. Transfer
7. strewin basket
8. Stop 30 minutes to rinse
9. Weighing and putting in bag (5000 + _100 gr)and
control
10. Vacuum
11. putting in carton
12. labeling and control
13. putting in Refrigerator
14. Transfer to a Transportation car
Frozen soup vegetable production line:
Production stages:
1. Cleaning the vegetable
2. Transfer
3. chlorination two stages
4. Transfer
5. disinfected with Percidine
6. Transfer
7. physical Seperationand quality control
8. Transfer
9. maintenance to rinse
10. chopping
11. Packaging
12. Vacuum
13. putting in carton
14. Transfer
15. putting in Refrigerator
Fifth step: Verification of OPC and processing and
verification of control Measure : Approval of safety team
in accordance with the production line and OPC.
Responsible Ms Moghadam
Sixth step: Hazard identification and determination of
acceptable levels

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Hazards more than 4 will be analysis

Step: Washing and rinsing
Hazard: dirt (chemical)
Severity: 3 Occurrence: 2 Significance: important
Storage in refrigerator:
Hazard: drop in temperature - microbial
contamination
Severity: 4 occurrence: 1 Significance: important

Seven step: selection and assessment of control A

measures
evaluated Items: the impact ,of possibility of
monitoring-control measures place in system-
failure possibility – Severity
Points are from 1 to 4 .Scores are based on total
points.
CCP = more than points 20
OPRP = less than points 20
Eighth and ninth Steps
Determination of Critical limits and system for the
monitoring o Critical Control points
7.4 Hazard analysis Temperature must be than less -8. In this case all
N/A 7.6 Establishing the HACCP plan product must be isolated and tested
7.8 Verification planning
Data analysis and verification

Data analysis and verification result:

Based on Identifying and evaluations hazards :28
hazards identified 12 OPRP and 11 CCP and 5 CP
For all CCP and OPRP verification plan was
considered.
For all CCP , specification form control of Critical
point (F07-P04)was observed...
Identified OPRP appropriate verification was
considered.
: A

Establishing the Personal hygiene:

operational
N/A 7.5 prerequisite
Health card of following staff were observed
programmes issued 94/10/21 Fatima Gholampoor
(PRPs) issued 94/10/21 Abbas Alizadeh year
issued 94/21/10 Vahid Khanjari

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Personal protective equipment, including Cap -

work clothes - mask ,Gloves
Culture (V.R.B.A) has prepared base on
instruction.
Records were reviewed for Mr. Mousavi in May.
Washing and disinfectant:
Cleaning of Salon is done according to C & D
schedule. Raw materials are stored on pallets.
Separation is done to avoid cross-contamination.
temperature is check consistently records for last
month was observed.

Cleaning program operator knife peeled onions

were investigated. Daily Cleaning and
disinfectant is done.
Cleaning and disinfection Knife using for onion
is done daily, records of current day was
observed.
Drying stage:
Hazard: physical objects
Severity :2
Occurrence :1
Importance: Significant
Control measures: individual health control and
control of appearance
Action Type: PRPs

Storage in refrigerator:
Hazard: drop in temperature - microbial
contamination
Severity: 4 occurrence: 1 Significance: important
Control measures: PM of cold air system
Action Type: PRPs
   

FORM‐009_V4_QMS MDD                                     Issued: July 9, 2003                                                        Revised: March 2013                                                       Page 14 of 16 
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By exception, we indicate the specific Strengths and weakness of the organization in light of the management system, as we perceive and seen through
processes in reference to requirements of the criteria being ascribed as these apply and relate to the assessment plan and planning of the assessment.
This aspect relates to Accreditation Body as it does to the protection of consumers in the client-organization’s role within their respective supply – chain.

Disclaimers: (1) herein, we reiterate that any suggestion or opinion that the assessment team expresses does not construe to be a contractual
requirement. (2) The degree of certainty in conclusions increases by the competence of the assessment team as well as the attestation within the
assessment protocol, values, mission and vision under which we operate for the protection of consumers, still remains a certain level of uncertainty.

Strength Weakness

Waste (over 20%)

High quality of raw materials FIFO in refrigerator of fresh Vegetable

 
 

action Request Type I Form-008 – as we indicate and that each of the RA addresses the basic four (4) questions
as seen in Form-008:N/A

action Request Type II Form-008 – as we indicate and that each of the AR addresses the basic four (4) questions
as seen in Form-008:  

Production Entrance doors have no jacks. 

For some of NCs root analysis and effectiveness has not done.

Observation Form-018 – with uniquely specific identification: N/A

ATL: Akbar Shams DATE: 4 Jun 2016

END of REPORT

FORM‐009_V4_QMS MDD                                     Issued: July 9, 2003                                                        Revised: March 2013                                                       Page 15 of 16 
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FORM-014 – Opening Meeting Checklist FORM-009 – MS Reporting,

FORM-017 – Closing Meeting Checklist FORM-008 – RA / AR, as requires
FORM-005 – Participants of opening & closing meetings FORM-018 – OBS, as requires
FORM-004 – Assessment Plan FORM-010 – As requires, recommendation for CoR
FORM-007 – Planning onto -004, as process determined FORM-026 – Assessment documents check-sheet, optional

FORM‐009_V4_QMS MDD                                     Issued: July 9, 2003                                                        Revised: March 2013                                                       Page 16 of 16