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| ATTACHMENT 2: M&TE Evaluation Report         |                       |
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| **5006-2**                                   | ![](medi              |
|                                              | a/image1.png){width=" |
| **M&TE Evaluation Report\                    | 1.6597222222222223in" |
| **                                           | height="0.859722      |
|                                              | 2222222223in"}Records |
|                                              | Use only              |
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| **Section I.**                               |                       |
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| M&TE Identifier:                             |                       |
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| M&TE Description:                            |                       |
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| The M&TE identified above:                   |                       |
|                                              |                       |
| was out of tolerance.                        |                       |
|                                              |                       |
| could not be calibrated.                     |                       |
|                                              |                       |
| could not be located.                        |                       |
|                                              |                       |
| Was the device used to collect data?         |                       |
|                                              |                       |
| No, Complete Section III of this form.       |                       |
|                                              |                       |
| Yes, determine if the data collected were    |                       |
| affected by the identified condition and     |                       |
| document the results in Section II of this   |                       |
| form.                                        |                       |
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| **Section II.**                              |                       |
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| Evaluation:                                  |                       |
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| a\) Identify the data collected:             |                       |
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| b\) Identify the processes monitored:        |                       |
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| c\) Identify the notebooks reviewed:         |                       |
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| Conclusion: The validity of results obtained |                       |
| with the M&TE or Standard and the            |                       |
| acceptability of data collected since the    |                       |
| last calibration have been evaluated as      |                       |
| required, and is documented as follows:      |                       |
|                                              |                       |
| data is acceptable (complete Section III,    |                       |
| below).                                      |                       |
|                                              |                       |
| data is unacceptable (initiate               |                       |
| nonconformance report and complete Section   |                       |
| III, below).                                 |                       |
|                                              |                       |
| Nonconformance report number:                |                       |
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| **Section III.**                             |                       |
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| The impact of the identified condition has   |                       |
| been evaluated by an SME.                    |                       |
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| [     ]{.underline}                          |                       |
|                                              |                       |
| Print name and Title Signature Date          |                       |
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