Name of the QA Program Being Audited

Name of the QA Program Being Audited

QA: Nonpermanent

Office of Environmental Management

Audit Report

YY-DOE-AU-0XX

Name of the QA program being audited

Location of the audit

Month, DD-DD, YYYY when audit was conducted

Preparer:

Insert Audit Team Leader NameDate

Insert Audit Team Leader Organization

Approved:

Robert D. Murray Date

Director

Office of Standards and Quality Assurance

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QA: Nonpermanent

1.0SCOPE

Representatives from the Office of Standards and Quality Assurance conducted a quality assurance audit of [Insert Audited Organization]. The audit team evaluated the adequacy and effectiveness of the [Select one of the following: High-Level Waste (HLW) or Spent Nuclear Fuel (SNF)] program implementation in compliance with the requirements of DOE/RW-0333P, Revision 20, Quality Assurance Requirements and Description (QARD). In addition, the audit team reviewed the effectiveness of corrective actions from previously closed corrective action reports. The status of the any remaining open corrective action reports from previous audits or surveillances was also evaluated by the audit team.

2.0TEAM

Alpha, Office of Standards and Quality Assurance, Audit Team Leader

Bravo, [Enter Organization or Company], [Select one: Auditor or Technical Specialist]

Charlie, [Enter Organization or Company], [Select one: Auditor or Technical Specialist]

Delta, [Enter Organization or Company], [Select one: Auditor or Technical Specialist]

3.0PROCEDURES

The audit team was qualified per the effective revision of Administrative Procedure AP-2.1Q, Qualification of Personnel. The effective versions of the following EM procedures governed the conduct of the audit:

  • AP-16.1Q, Corrective Action
  • AP-18.1Q, Audits

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QA: Nonpermanent

4.0WASTE ACCEPTANCE IMPACTINGITEMS/ACTIVITIES AND APPLICABLE REQUIREMENTS

Item or Activity / Applicable Requirements
[Include description of item or activity from the audited organization’s list of waste acceptance impacting items or activities.]
[In cases of programs not having a list of waste acceptance impacting items or activities (e.g. HLW and UNF Oversight Program,), this column can be deleted.] / QARD
x.0Section Title
y.0Section Title
WASRD (as needed)
x.0Section Title
y.0Section Title

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QA: Nonpermanent

5.0RESULTS

  • X conditions adverse to quality/significant conditions adverse to quality (CAQs/SCAQs)
  • Y recommendations for improvement
  • noteworthy practices

Corrective Action Reports (CARs)

FY-CAQ-XXX[Summarize the CAQ/SCAQ]

Requirement(s):

[Cite the requirements violated in the following hierarchal order: QARD, project plan, implementing procedure, etc.]

This CAQ/SCAQ is presented in Checklist Item X-Y.

Recommendations for Improvement

Recommendation #X[Summarize the recommendation in active voice.]

This recommendation is presented in Checklist Item X-Y.

Noteworthy Practices

Noteworthy Practice #Ω[Summarize the noteworthy practice in active voice.]

This noteworthy practice is presented in Checklist Item X-Y.

6.0CONCLUSIONS

The audit team concluded that the [Insert name of audited organization] is effectively implementing the QARD except as noted in the [x] CARs identified during the audit.

Documents Reviewed

QARD Criteria 1 - Organization

  • Document Number, Revision (Or date if no revision is available), Document Title in italics.

Notes:

  1. Provide a list of documents for each QARD Criteria audited.
  2. Within each criterion, the documents will be listed in the following order:
  3. Plans
  4. Procedures
  5. Supporting Documents

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QA: Nonpermanent

Personnel Contacted
Name / Organization and Position Title / Pre-Audit Meeting / During the Audit / Management Briefing / Post-Audit Meeting
[Last Name,First Name] / [Agency or Company], [Organization Title], [Position Title]

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