Functional Acceptance Certificate for Systems
Use this form to record system details, functional review results, exceptions, and final acceptance sign-off for a delivered system.
System and Project Details
System Name
*
Project Name
*
System or Module Version
Delivery or Release Identifier
Environment Being Accepted
*
Please Select
Production
Staging
UAT
Development
Other
Vendor or Implementation Team Name
Client or Department Name
*
Acceptance Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reference Document or Ticket Number
Functional Acceptance Review
Acceptance Criteria
*
Overall Functional Decision
*
Pass
Pass with Exceptions
Fail
Not Tested
Outstanding Defects or Issues
Issue Severity
Please Select
Low
Medium
High
Critical
No Issues
Exceptions or Deviations from Scope
Retesting Required
*
Yes
No
Reviewer Comments
Acceptance Decision and Sign-Off
Acceptance decision
*
Accepted
Accepted with Exceptions
Rejected
Conditional notes or follow-up actions
Approver name
*
First Name
Last Name
Approver role/title
*
Organization/department
Approval date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Final sign-off signature
Submit Certificate
Submit Certificate
Should be Empty: