Prefilled Syringe Inspection Checklist Form
Complete this checklist to document the inspection of prefilled syringes. All fields are required for a thorough inspection.
Inspector Name
*
First Name
Last Name
Inspection Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Syringe Batch/Lot Number
*
Visual Clarity (solution is clear, no discoloration)
*
Pass
Fail
No Visible Particulates Present
*
Pass
Fail
Correct Labeling and Legibility
*
Pass
Fail
Cap Integrity (cap is secure and undamaged)
*
Pass
Fail
Fill Volume (within specification)
*
Pass
Fail
No Leaks Observed
*
Pass
Fail
Plunger Movement (smooth, no sticking or resistance)
*
Pass
Fail
Submit Inspection
Should be Empty: