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Appendix C. Model Inspection Report Forms

Random Package Report........................................................................................................................... 185

Random Package Report – Example......................................................................................................... 186

Standard Package Report .......................................................................................................................... 187

Standard Package Report – Example........................................................................................................ 188

Standard Package Report – Animal Bedding........................................................................................... 189

Measurement Grid and Package Error Worksheet for Cylindrical and Square or Rectangular Test 

Measures................................................................................................................................. 190

Ice Glazed Package Worksheet................................................................................................................. 191

Ice Glazed Package Worksheet – Example............................................................................................... 192

Ice Glazed Package Report ....................................................................................................................... 193

Ice Glazed Package Report – Example..................................................................................................... 194

Determining the Free Liquid and Net Volume of Oysters Worksheet...................................................... 195

Determining the Free Liquid and Net Volume of Oysters Worksheet – Example .................................. 196

Chitterlings Worksheet – Category A....................................................................................................... 197

Chitterlings Worksheet – Category A – Example..................................................................................... 198

Chitterlings Worksheet – Category B....................................................................................................... 199

Chitterlings Worksheet – Category B – Example..................................................................................... 200

Peat Moss Labeled by Volume Package Worksheet – Dimensional Procedure ....................................... 201

Borax Audit Worksheet ............................................................................................................................ 202

Softwood Lumber Worksheet................................................................................................................... 203

Softwood Lumber Worksheet................................................................................................................... 205

Structural Plywood Sheets and Wood-Based Structural Panels Worksheet ............................................. 207

Structural Plywood Sheets and Wood-Based Structural Panels Worksheet ............................................. 209
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Handbook 133 – 2023 Appendix C. Model Inspection Report Forms

185

Date: Random Package Report Sampling Plan:  A  B Report Number:

Location (name, address): Product/Brand Identity: Manufacturer: Container Description:

Lot Codes:

1. Labeled Quantity:

(Enter weight for each 

package in Column 1 

below.)

2. Unit of Measure: 3. MAV: (Look up the MAV for each package 

with a minus error (−), convert it to dimensionless 

units and enter this value in the Box 4 column 

below.)

5. Inspection Lot Size: 6. Sample Size (n):

7. Initial Tare 

Sample Size:

8. Number of MAVs 

Allowed:

9. Range of Package 

Errors (Rc):

10. Range of Tare 

Weights (Rt):

11. Rc/Rt :

(Box 9 ÷ Box 10 = )

12. Total No. of Tare 

Samples:

13. Avg. Tare Wt:

 Used Dry Tare  Wet Tare  Unused Dry Tare

13a.  Tare Correction

 Moisture Allowance

 Not Applicable

14. Nominal Gross Wt:

(Labeled Wt+Box 13−Box 

13a=)

Pkg 1 Pkg 2 Pkg 3 Pkg 4 Pkg 5 Pkg 6 Pkg 7 Pkg 8 Pkg 9 Pkg 10

a. Gross Wt

b. Tare Wt

 c. Net Wt

d. Package Error

Product Description, Lot Code, Unit Price

Money Errors Column 1

Labeled Net

Weight

Package Errors 4. MAV

Dimensionless

Units − + − +

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

Totals

15. Total Error: 16. Number of unreasonable 

minus (−) errors: (Compare each 

package error with the MAV in 

Column 4.)

17. Is Box 16 greater than Box 8?

 Yes, lot fails

 No, go to Box 18

18. Avg. error in 

dimensionless units:

(Box 15 ÷ Box 6 =) 

19. Avg. error in 

labeled units: (Box 18 ×

Box 2 =)

20. Does Box 18 = zero (0) or Plus

(+)?

 Yes, lot passes, go to Box 25 

 No, go to Box 21

21. Compute Sample 

Standard Deviation:

22. Sample Correction Factor: 23. Compute Sample Error Limit: (Box 21 × Box 22 =)

24. Disregarding the signs, is Box 18 larger than Box 23?

 Yes, lot fails, go to Box 25  No, lot passes, go to Box 25

25. Disposition of Inspection Lot:

 Approved  Rejected 

Comments: Official’s Signature:

Acknowledgement of Report:
Appendix C. Model Inspection Report Forms Handbook 133 – 2023

186

Date:

January 20, 2010 Random Package Report – Example Sampling Plan:  A  B

Report Number:

17

Location (name, address):

L&O Market

MacCorkle Ave.

Charleston, WV 25171

Product/Brand Identity:

Ground Chuck

Manufacturer:

Meat Dept. – L&O Market

Container Description:

2S Tray w/soaker and 

Lot Codes: plastic wrap

1, 19, 99

1. Labeled Quantity:

(Enter weight for each 

package in Column 1 

below.) 

2. Unit of Measure:

0.001 lb

3. MAV: (Look up the MAV for each package 

with a minus error (−), convert it to dimensionless 

units and enter this value in the Box 4 column 

below.)

5. Inspection Lot Size: 

23

6. Sample Size (n):

12

7. Initial Tare 

Sample Size:

2

8. Number of MAVs 

Allowed: 

0

9. Range of Package 

Errors (Rc):

10

10. Range of Tare 

Weights (Rt):

1

11. Rc/Rt:

(Box 9 ÷ Box 10 = )

10

12. Total No. of Tare 

Samples:

2

13. Avg. Tare Wt: 

0.020 lb

 Used Dry Tare  Wet Tare  Unused Dry Tare

13a.  Tare Correction

 Moisture Allowance

 Not Applicable

14. Nominal Gross Wt:

(Labeled Wt+Box 13−Box 

13a=)

Label Wt+0.020 lb

Pkg 1 Pkg 2 Pkg 3 Pkg 4 Pkg 5 Pkg 6 Pkg 7 Pkg 8 Pkg 9 Pkg 10

a. Gross Wt 1.852 lb 1.223 lb

b. Tare Wt

 

0.020 lb 0.021 lb

c. Net Wt 1.832 lb 1.202 lb

d. Package Error −18 −8

Product Description, Lot Code, Unit Price

Money Errors Column 1

Labeled Net

Weight

Package Errors 4. MAV

Dimensionless 

− + − + Units

1. Ground Chuck – 1, 19, 99 – $1.79 per lb 1.85 lb 18

2. 1.21 lb 7

3. 1.56 lb 8

4. 1.98 lb 14

5. $ 0.04 1.07 lb 23 44

6. 1.55 lb 16

7. 1.02 lb 2

8. $ 0.04 1.44 lb 25 56

9. 1.33 lb 16

10. 2.03 lb 20 70

11. 1.73 lb 14

12. 1.16 lb 11

13.

14.

15.

16.

Totals −174

15. Total Error:

− 174

16. Number of unreasonable 

minus (−) errors: (Compare each 

package error with the MAV in 

Column 4.) 

0

17. Is Box 16 greater than Box 8?

 Yes, lot fails

 No, go to Box 18

18. Avg. error in 

dimensionless units: 

(Box 15 ÷ Box 6 =) 

− 14.5

19. Avg. error in labeled 

units: (Box 18 × Box 2 =)

− 0.014 lb

20. Does Box 18 = Zero (0) or Plus 

(+)?

 Yes, lot passes, go to Box 25 

 No, go to Box 21

21. Compute 

Sample Standard 

Deviation:

6.721

22. Sample Correction Factor:

0.635

23. Compute Sample Error Limit: (Box 21 × Box 22 =)

4.267

24. Disregarding the signs, is Box 18 larger than Box 23?

 Yes, lot fails, go to Box 25  No, lot passes, go to Box 25

25. Disposition of Inspection Lot:

 Approved  Rejected 

Comments Official’s Signature:

Acknowledgement of Report:
Handbook 133 – 2023 Appendix C. Model Inspection Report Forms

187

Date:

Standard Package Report Sampling Plan:  A  B

Report Number:

Location (name, address): Product/Brand Identity: Manufacturer: Container 

Description:

Lot Codes:

1. Labeled Quantity: 2. Unit of Measure: 3. MAV: 4. MAV (dimensionless 

units):

(Box 3 ÷ Box 2 =)

5. Inspection Lot Size: 6. Sample Size (n):

7. Initial Tare 

Sample Size:

8. Number of MAVs 

Allowed:

9. Range of 

Package Errors 

(Rc):

10. Range of Tare Weights 

(Rt):

11. Rc/Rt: 

(Box 9 ÷ 10 =)

12. Total Number of 

Tare Samples:

13. Average Tare Wt: 

 Used Dry Tare Wet Tare Unused Dry Tare

13a.  Tare Correction 

 Moisture Allowance

 Vacuum Pack

 Not Applicable

14. Nominal Gross Wt: 

(Box 1 + Box 13 − Box 13a =)

Pkg 1 Pkg 2 Pkg 3 Pkg 4 Pkg 5 Pkg 6 Pkg 7 Pkg 8 Pkg 9 Pkg 10

a. Gross Wt

b. Tare Wt

 c. Net Wt

d. Package Error

− + − + − + − +

1. 13. 25. 37.

2. 14. 26. 38.

3. 15. 27. 39.

4. 16. 28. 40.

5. 17. 29. 41.

6. 18. 30. 42.

7. 19. 31. 43.

8. 20. 32. 44.

9. 21. 33. 45.

10. 22. 34. 46.

11. 23. 35. 47.

12. 24. 36. 48.

Total: Total: Total: Total: Total: Total: Total: Total:

15. Total Error: 16. Number of unreasonable minus (−) errors 

(compare each package error with Box 4):

17. Is Box 16 greater than 

Box 8?

 Yes, lot fails

 No, go to Box 18 

18. Average error in 

dimensionless units:

(Box 15 ÷ Box 6 =) 

19. Average error in 

labeled units: 

(Box 18 × Box 2 =)

20. Does Box 18 = Zero (0) or Plus (+)?

 Yes, lot passes, go to Box 25 

 No, go to Box 21

21. Compute Sample 

Standard Deviation:

22. Sample Correction 

Factor:

23. Compute Sample Error Limit:

(Box 21 × Box 22 =)

24. Disregarding the signs, is Box 18 larger than Box 23?

 Yes, lot fails, go to Box 25  No, lot passes, go to Box 25

25. Disposition of Inspection Lot:

 Approved  Rejected

Comments: Official’s Signature:

Acknowledgement of Report:
Appendix C. Model Inspection Report Forms Handbook 133 – 2023

188

Date:

January 20, 2010 Standard Package Report – Example Sampling Plan:  A  B

Report Number:

16

Location (name, address):

Volunteer Market

18765 Alcoa Highway

Knoxville, TN 37920

Product/Brand Identity:

Community Group Cookies (Thin Mints)

Manufacturer:

ABC Cookies Inc.

1069 Capitol Avenue

Nashville, TN 37204

Container 

Description:

Cardboard Box/

Lot Codes: Plastic Liner

April 2009 A & B

1. Labeled Quantity:

453 g (1 lb)

2. Unit of Measure:

0.001 lb

3. MAV:

0.044 lb

4. MAV (dimensionless 

units):

(Box 3 ÷ Box 2 =) 44

5. Inspection Lot Size:

172

6. Sample Size (n):

12

7. Initial Tare 

Sample Size:

2

8. Number of MAVs Allowed:

0

9. Range of 

Package 

Errors (Rc):

24

10. Range of Tare Weights 

(Rt):

2

11. Rc/Rt: 

(Box 9 ÷ 10 =)

12

12. Total Number of 

Tare Samples:

2

13. Average Tare Wt: 

0.014 lb

 Used Dry Tare  Wet Tare  Unused Dry Tare

13a.  Tare Correction 

 Moisture Allowance

 Vacuum Pack

 Not Applicable

14. Nominal Gross Wt: 

(Box 1 + Box13 − Box 13a =)

1.014 lb

Pkg 1 Pkg 2 Pkg 3 Pkg 4 Pkg 5 Pkg 6 Pkg 7 Pkg 8 Pkg 9 Pkg 10

a. Gross Wt 1.052 lb 1.026 lb

b. Tare Wt

 

0.015 lb 0.013 lb

c. Net Wt 1.037 lb 1.013 lb

d. Package Error 37 13

− + − + − + − +

1. 38 13. 25. 37.

2. 12 14. 26. 38.

3. 8 15. 27. 39.

4. 4 16. 28. 40.

5. 3 17. 29. 41.

6. 2 18. 30. 42.

7. 12 19. 31. 43.

8. 3 20. 32. 44.

9. 4 21. 33. 45.

10. 1 22. 34. 46.

11. 0 23. 35. 47.

12. 6 24. 36. 48.

Total:

9

Total:

84

Total: Total: Total: Total: Total: Total:

15. Total Error:

+ 75

16. Number of unreasonable minus (−) errors 

(compare each package error with Box 4):

0

17. Is Box 16 greater than 

Box 8?

 Yes, lot fails

 No, go to Box 18 

18. Average error in 

dimensionless units:

(Box 15 ÷ Box 6 =) 

+ 6.25

19. Average error in 

labeled units: 

(Box 18 × Box 2 =)

+ 0.006 lb

20. Does Box 18 = Zero (0) or Plus (+)?

 Yes, lot passes, go to Box 25 

 No, go to Box 21

21. Compute Sample 

Standard Deviation:

22. Sample Correction 

Factor:

23. Compute Sample Error Limit: 

(Box 21 × Box 22 =)

24. Disregarding the signs, is Box 18 larger than Box 23?

 Yes, lot fails, go to Box 25  No, lot passes, go to Box 25

25. Disposition of Inspection Lot:

 Approved  Rejected

Comments:

Lot Passes

Official’s Signature:

Acknowledgement of Report:
Handbook 133 – 2023 Appendix C. Model Inspection Report Forms

189

Date: Standard Package Report –

Animal Bedding

Sampling Plan A – Table 2-1., Appendix 

A. in NIST Handbook 133

Report Number:

Location (name, address): Product/Brand 

Identity:

Manufacturer: Container 

Description: 

Lot Codes:

1. Labeled 

Quantity 

(Usable 

Volume):

2. Unit of 

Measure:

3. MAV:

(5 % of labeled 

quantity)

4. MAV:

(0.05 × Box 1. Usable 

Volume) 

5. Inspection 

Lot Size: 

6. Sample Size (n):

7. Number of 

Unreasonable 

Package Errors 

Allowed for Sample 

Size:

Gross Weight for Audit Testing Package Error Test Notes − +

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

Total: Total:

8. Total 

Error: 

9. Number of unreasonable minus (−) 

errors (compare each package error with 

Box 4): 

10. Is Box 9 greater 

than Box 7?

 Yes, lot fails go to 

Box 17

 No, go to Box 11. 

11. Calculate Average Error: 

(Box 8 ÷ Box 6 =)

12. Does Box 11 = Zero (0) or 

Plus (+)?

 Yes, lot passes, go to Box 17 

 No, go to Box 13, 14, 15 & 16

13. Compute Sample 

Standard Deviation:

14. Sample 

Correction Factor:

15. Compute Sample Error Limit 

(SEL): (Box 13 × Box 14 =)

16. Disregarding the signs, is Box 11 larger than Box 15?

 Yes, lot fails, go to Box 17 

 No, lot passes, go to Box 17

17. Disposition of Inspection Lot:

 Approve  Reject

Comments: Official’s Signature:

Acknowledgement of Report:
Appendix C. Model Inspection Report Forms Handbook 133 – 2023

190

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3-2023

Measurement Grid and Package Error Worksheet 

for Cylindrical and Square or Rectangular Test Measures

Complete this for Cylindrical Test Measures

Sample Package ______________ Labeled Expanded Volume (L): _______________

A. Interior Height of Test Measure: __________________ B. Radius of Test Measure (r): ___________

C. Average Depth (Sum of Measurements ÷ 9): _______________

D. Average Height of Product (= A − C): __________________

E. Volume (L): _____________ = 3.14159265 × r2 (B2

): __________ × D: ________ ÷ 1 000 000

F. Package Error (L): ____________ = Labeled Volume (L): ____________ − E (L): _____________

Volume is calculated using: Volume in liters = πr2

h For example: if r2 is 23035 and height of product is 109.26 

then ((Pi) 3.14159265 × r2

 (23035) × 109.26) ÷ 1 000 000 = 7.90 L

Complete this for Square or Rectangular Test Measures

Sample Package ______________ Labeled Expanded Volume (L): _______________

A. Interior Height of Test Measure: ___________ B. Area of Test Measure Base (L × W): ___________

C. Average Depth (Sum of Measurements ÷ 9): _______________

D. Average Height of Product (= A − C): __________________

E. Volume (L): ___________ = B. Area of Test Measure Base: __________ × D: ________ ÷ 1 000 000

F. Package Error (L): ____________ = Labeled Volume (L): ____________ − E (L): _____________

Volume is calculated using: Volume in liters = (lw)h For example: If length and width are 609.6 the area of the 

measure’s base is 371612. If the Average Height of the Product is 109.26 then: 

* Area of Test Measure Base (371612) × Average Height of Bedding (109.26) ÷ 1 000 000 = 40.6 L

(Added 2016)
Handbook 133 – 2023 Appendix C. Model Inspection Report Forms

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3-2023

Ice Glazed Package Worksheet

STEP

1. Package Price (if standard pack) $ ____________ Price Per Pound (if random pack) $ ______________

Lot Size: ____________ Sample Size: ___________ Unit of Measure: _________

2. Number each package. Weigh each package for the Gross Package Weight and enter in Row 1. 

3. Enter Labeled Net Weight in Row 2. (If dual units determine the larger unit.) ___________

4. Record the Maximum Allowable Variation (MAV) in Row 3.

5. Weigh the receiving pan = _____________ (enter in Row 4). (Clean and dry the receiving pan and verify the 

weight after each use. Thoroughly clean the sieve.)

6. Deglaze the product. Remove each package from the low temperature storage. Open the package immediately 

and place the contents in the sieve or other draining device (e.g., colander) under a gentle spray of cold water. 

Carefully agitate the product. Handle with care to avoid breaking the product. Continue the spraying process 

until all the ice glaze that is seen or felt is removed.

7. Without shifting the product, incline the sieve to an angle of 17° to 20° (incline to facilitate drainage) and drain 

for two minutes using a stopwatch.

8. Immediate transfer the entire product to the receiving pan to determine the net weight. 

9. To calculate the net weight (receiving pan and product) – (receiving pan) = Net Weight (enter in Row 5)

10. Calculate ± Package error (net weight [Row 5] – labeled net weight [Row 2]) = ± Error, (enter in Row 6).

Row Package 1 2 3 4 5 6 7 8 9 10 11 12

1

Gross Pkg. 

Weight

(Step 2)

2

Labeled Net 

Weight

(Step 3)

3

MAV

(Step 4)

4

Receiving 

Pan Weight

(Step 5)

5 Net Weight

(Step 9)

6

± Error

(Step 10)

Used Dry Tare _______

Transfer data from the “Ice Glazed Package Worksheet” to the “Ice Glazed Package Report”

(Added 2010)
Appendix C. Model Inspection Report Forms Handbook 133 – 2023

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3-2023

Ice Glazed Package Worksheet – Example

STEP

1. Package Price (if standard pack) $ 6.99 Price Per Pound (if random pack) $ _____________

Lot Size: 6 Sample Size: 6 Unit of Measure: 0.001 lb

2. Number each package. Weigh each package for the Gross Package Weight and enter Row 1. 

3. Enter Labeled Net Weight in Row 2. (If dual units determine the larger unit.) 1 lb/453 g

4. Record the Maximum Allowable Variation (MAV) in Row 3.

5. Weigh the receiving pan = 0.795 lb (enter in Row 4). (Clean and dry the receiving pan and verify the weight 

after each use. Thoroughly clean the sieve.)

6. Deglaze the product. Remove each package from the low temperature storage. Open the package immediately 

and place the contents in the sieve or other draining device (e.g., colander) under a gentle spray of cold water. 

Carefully agitate the product. Handle the product with care to avoid breaking the product. Continue the spraying 

process until all the ice glaze that is seen or felt is removed.

7. Without shifting the product, incline the sieve to an angle of 17° to 20° (incline to facilitate drainage) and drain 

for two minutes using a stopwatch.

8. Immediately transfer the entire product to the receiving pan to determine the net weight. 

9. To calculate the net weight (receiving pan and product) – (receiving pan) = Net Weight (enter in Row 5)

10. Calculate ± Package error (net weight [Row 5] – labeled net weight [Row 2]) = ± Error, (enter in Row 6).

Row Package 1 2 3 4 5 6 7 8 9 10 11 12

1

Gross Pkg. 

Weight

(Step 2)

1.180 1.205 1.110 1.150 1.000 1.210

2

Labeled Net 

Weight

(Step 3)

1.000 1.000 1.000 1.000 1.000 1.000

3

MAV

(Step 4)

0.044 0.044 0.044 0.044 0.044 0.044

4

Receiving Pan 

Weight 

(Step 5)

0.795 0.795 0.795 0.795 0.795 0.795

5

Net Weight

(Step 9)

0.985 0.975 1.000 1.030 0.930 0.980

6

± Error 

(Step10) −0.015 −0.025 0 +0.030 −0.070 −0.020

Used Dry Tare 0.025 lb

Transfer data from the “Ice Glazed Package Worksheet” to the “Ice Glazed Package Report”

(Added 2010)
Handbook 133 – 2023 Appendix C. Model Inspection Report Forms

193

Date: Ice Glazed Package Report Sampling Plan:  A  B Report 

Number:

Location (name, address): Product/Brand Identity: Manufacturer: Container 

Description:

Lot Codes:

1. Standard Pack Labeled 

Quantity:

(If random packed, enter weight for 

each package in Column 1 below.)

2. Unit of Measure: 3. MAV: Look up the MAV for each package 

with a minus (−) error, enter value in the Box 4

column below.

5. Inspection 

Lot Size:

6. Sample 

Size (n):

7. Price per lb: 

7a. Standard Pack: Package Price ___________ divide by (Box 1) = ____________

7b. Random Pack: Labeled Price per lb ___________

8. No. of 

MAVs 

Allowed:

Pkg 1 Pkg 2 Pkg 3 Pkg 4 Pkg 5 Pkg 6 Pkg 7 Pkg 8 Pkg 9 Pkg 10 Pkg 11 Pkg 12

Pkg. Gross Wt

a. Labeled Net Wt

b. Gross: 

Rec. Pan & deglazed 

product Wt

c. Tare: 

Rec. Pan Wt

d. Net Wt :

(Box b − Box c= )

e. Package Error:

(Box d − Box a = )

Package 

#

Column 1

Labeled Net Weight

(random pack only)

Package Errors 4. MAV

Dimensionless Units − +

1

2

3

4

5

6

7

8

9

10

11

12

Totals f. g.

9. Total Error:

(add Row e or Box f + 

g)

10. Number of Unreasonable Minus (−) Errors:

(compare each package error with the MAV in the 

Box 4 column)

11. Is Box 10 greater than 

Box 8?

 Yes, lot fails 

 No, go to Box 12

12. Avg. Error: (Box 9 ÷ Box 6 = )

13. Does Box 12 = Zero (0) or Plus (+)?

 Yes, lot passes, go to Box 18

 No, go to Box 14

14. Compute Sample 

Standard Deviation:

15. Sample Correction Factor: 16. Compute Sample Error Limit:

(Box 14 × Box 15 =)

17. Disregarding the signs, is Box 12 larger than Box 16?

 Yes, lot fails, go to Box 18

 No, lot passes, go to Box 18

18. Disposition of Inspection Lot:

 Approved  Rejected 

19. Economic Impact:

(Box 12 × Box 7 × Box 5 = )

Comments: Official’s Signature:

Acknowledgement of Report:
Appendix C. Model Inspection Report Forms Handbook 133 – 2023

194

Date:

January 20, 2010 Ice Glazed Package Report – Example Sampling Plan:  A  B

Report 

Number:

103

Location (name, address):

Ocean Fresh Market

101 8th Street

Key West, FL

Product/Brand Identity:

Raw/Peeled Shrimp 71 – 90 Count

Manufacturer:

Ocean Fresh

Container 

Description:

Lot Codes: Plastic

1. Standard Pack Labeled 

Quantity: 453 g (1 lb)

(If random packed, enter weight for 

each package in Column 1 below.)

2. Unit of Measure:

0.001 lb

3. MAV: Look up the MAV for each package 

with a minus (−) error, enter value in the Box 4 

column below.

0.044 lb

5. Inspection 

Lot Size:

6

6. Sample 

Size (n):

6

7. Price per lb: 

7a. Standard Pack: Package Price $ 6.99 divide by (Box 1) = $ 6.99 

7b. Random Pack: Labeled Price per lb ___________

8. No. of 

MAVs 

Allowed

 0

Pkg 1 Pkg 2 Pkg 3 Pkg 4 Pkg 5 Pkg 6 Pkg 7 Pkg 8 Pkg 9 Pkg 10 Pkg 11 Pkg 12

Pkg. Gross Wt 1.180 1.205 1.100 1.150 1.000 1.210

a. Labeled Net Wt 1.000 1.000 1.000 1.000 1.000 1.000

b. Gross: 

Rec. Pan & deglazed 

product Wt

c. Tare: 

Rec. Pan Wt 0.795 0.795 0.795 0.795 0.795 0.795

d. Net Wt 

(Box b − Box c= ) 0.985 0.975 1.000 1.030 0.930 0.980

e. Package Error

(Box d − Box a = ) − 0.015 − 0.025 0 + 0.030 − 0.070 − 0.020

Package 

#

Column 1

Labeled Net Weight

(random pack only)

Package Errors 4.

MAV

Dimensionless Units − +

1

2

3

4

5

6

7

8

9

10

11

12

Totals f. g.

9. Total Error:

(add Row e or Box f + g)

− 0.100

a. Number of Unreasonable Minus (−) 

Errors: (compare each package error with the 

MAV in the Box 4 column)

1

11. Is Box 10 greater than 

Box 8?

 Yes, lot fails 

 No, go to Box 12

12. Avg. error: (Box 9 ÷ Box 6 = )

− 0.016

13. Does Box 12 = Zero (0) or Plus (+)?

 Yes, lot passes, go to Box 18 

 No, go to Box 14

14. Compute Sample 

Standard Deviation:

15. Sample Correction Factor: 16. Compute Sample Error Limit:

(Box 14 × Box 15 =)

17. Disregarding the signs, is Box 12 larger than Box 16?

 Yes, lot fails, go to Box 18 

 No, lot passes, go to Box 18

18. Disposition of Inspection Lot:

 Approved  Rejected 

19. Economic Impact:

(Box 12 × Box 7 × Box 5 = )

− 0.016 × $6.99 × 6 = $0.67

Comments:

Product found to contain less than the stated net contents. Failed due to MAV.

Official’s Signature:

Acknowledgement of Report:
Handbook 133 – 2023 Appendix C. Model Inspection Report Forms

195

Date: Determining the Free Liquid and Net Volume

of Oysters Worksheet 

Report Number:

Location (name, address): Product/Brand Identity: Manufacturer: Container 

Description:

Lot Codes:

1. Labeled Quantity: 2. Unit of Measure: 3. Inspection Lot Size: 4. Sample Size:

Amount of Free Liquid

Values

Steps: Pkg 1 Pkg 2 Pkg 3 Pkg 4 Pkg 5 Pkg 6 Pkg 7 Pkg 8 Pkg 9 Pkg 10

1. Weight of Dry Receiving Pan 

2. Gross Weight of Package 

Reference Temperature of Oysters 

7 °C (± 1) [45 °F (± 2)]

3. Tare Weight of Package

4. Net Weight of Oysters & Liquid 

(Step 2 – Step 3 = )

5. Weight of Receiving Pan and 

Drained Liquid

6. Weight of Free Liquid

(Step 5 – Step 1 = )

7. Percentage (%) of Free Liquid 

(Step 6 ÷ Step 4 × 100 =)

Net Volume

1. Test the oysters at the temperature of 7 °C (± 1) [45 °F (± 2)]. 

2. Establish the level of fill of the package using a depth gage. 

3. Empty and dry the package.

4. Refill the package with water to the level of the depth gage.

5. Record the amount of delivered water and then sum the quantities to obtain the total volume in the package.

Amount of Free Liquid Quantity of Water Delivered into Package

Pkg 1 Pkg 2 Pkg 3 Pkg 4 Pkg 5 Pkg 6 Pkg 7 Pkg 8 Pkg 9 Pkg 10

8. Flask Size

9. Flask Size 

10. Graduate or Cylinder

11. Graduate or Cylinder

12. Total

(8 + 9 + 10 = )

Comments: 
Appendix C. Model Inspection Report Forms Handbook 133 – 2023

196

Date:

December 20, 2013

Determining the Free Liquid and Net Volume 

of Oysters Worksheet – Example

Report Number:

1 of 2

Location (name, address):

Superchain Market

Main Street

Bradenton, FL

Product/Brand Identity:

World’s Best Oysters – Oyster Standard

Manufacturer:

World’s Best Packing

Beach Road, AL

Container 

Description:

Clear Plastic Tub 

with metal pull top

Lot Codes:

12/26/2012

1. Labeled 

Quantity:

12 fl oz (355 ml)

2. Unit of Measure:

0.001 lb

3. Inspection Lot Size:

206

4. Sample Size:

12

Amount of Free Liquid

Values

Steps: Pkg 1 Pkg 2 Pkg 3 Pkg 4 Pkg 5 Pkg 6 Pkg 7 Pkg 8 Pkg 9 Pkg 10

1. Weight of Dry Receiving Pan 11.841 11.841 11.841 11.841 11.841

2. Gross Weight of Package 0.871 0.884 0.920 0.869 0.8632

Reference Temperature of Oysters 

7 °C (± 1) [45 °F (± 2)] 44 °F 46 °F 44 °F 47 °F 45.5 °F

3. Tare Weight of Package 0.060 0.060 0.060 0.059 0.060

4. Net Weight of Oysters & Liquid 

(Step 2 – Step 3 = ) 0.811 0.824 0.86 0.81 0.803

5. Weight of Receiving Pan and 

Drained Liquid 12.020 12.121 12.120 12.031 12.242

6. Weight of Free Liquid

(Step 5 – Step 1 = ) 0.179 0.28 0.279 0.19 0.401

7. Percentage (%) of Free Liquid 

(Step 6 ÷ Step 4 × 100 =) 22 % 33 % 32 % 23 % 49 %

Net Volume

1. Test the oysters at the temperature of 7 °C (± 1) [45 °F (± 2)]. 

2. Establish the level of fill of the package using a depth gage. 

3. Empty and dry the package.

4. Refill the package with water to the level of the depth gage.

5. Record the amount of delivered water and then sum the quantities to obtain the total volume in the package.

Amount of Free Liquid Quantity of Water Delivered into Package

Pkg 1 Pkg 2 Pkg 3 Pkg 4 Pkg 5 Pkg 6 Pkg 7 Pkg 8 Pkg 9 Pkg 10

8. Flask Size

9. Flask Size 

10. Graduate or Cylinder

11. Graduate or Cylinder

12. Total

(8 + 9 + 10 = )

Comments: 
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3-2023

Inspector:

Chitterlings Worksheet – Category A

Date: (Net Weight & Purge Determinations)

Packer: Lot Code: Drain Pan Tare: 

 

 

Unit of Measure: 

Brand: 

Package Number

A B C D E

If Error Exceeds

MAV = Fail

F G

Labeled 

Net 

Weight

Package

Gross

Weight

Package

Tare

Weight

Actual 

Package 

Net

Weight

B – C =

Package 

Error

D – A =

Purged Net Wt

Weight of Drained 

Chitterlings (or 

Purged Liquid) and 

Drain Pan − Drain 

Pan Tare =

Purge %

(A – F) × 100

 A

1 %

2 %

3 %

4 %

5 %

6 %

7 %

8 %

9 %

10 %

11 %

12 %

Number of Unreasonable 

Errors Allowed: 

Table 2-9. MAV: 

E1 − Total Error : G1 − Total Purge: %

E2 – Average Error :

(E1 ÷ n = )

G2 – Average Purge:

(G1 ÷ n = ) %

G3 – Adjusted Average Purge: (G2 – Purge Sample Error Limit [PSEL] = ) %

NET WEIGHT COMPLIANCE: (1) If any of the minus package errors (see Column E) exceed the MAV, the sample fails. (2) If none exceeds 

the MAV and the Average Error (E2) is a positive number, the sample passes. (3) If the Average Error (E2) is a minus number, calculate the 

sample standard deviation and enter it below. (4) Use the Sample Correction Factor (SCF) to calculate the Sample Error Limit (SEL). (5) 

Disregarding the signs, (a) if the Average Error (E2) is larger than the SEL, the sample fails or (b) if the Average Error is less than the SEL the 

sample passes. 

Standard Deviation: × 0.635 (SCF) = (SEL)  Passed  Failed

PURGE COMPLIANCE: MAVs are not applied in the purge test (1) If the Average Purge Error (G2) is less than or equal to 20 %, the sample 

passes. (2) If the Average Purge Error is greater than 20 %, calculate the sample standard deviation and enter it below. (3) Use the Sample 

Correction Factor (SCF) to calculate the Purge Sample Error Limit (PSEL) in percent. (4) Subtract the PSEL from the Average Purge (G2) to 

obtain an Adjusted Average Purge (AAP) and enter that value in G3. (5)(a) If the AAP (G3) is greater than 20 %, the sample fails or (b) if the 

AAP (G3) is 20 % or less, the sample passes.

Standard Deviation: × 0.635 (SCF) = (PSEL) Purge (G3)  Passed  Failed 

Sample Disposition:
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Inspector: 

S. Inspector Chitterlings Worksheet – Category A – Example

Date: (Net Weight & Purge Determinations Worksheet)

July 12, 2016

Packer: Packer Inc.

1000 Roadway

PackingTown, USA

Lot Code: a342012 Drain Pan Tare: 

0.997 lb

Unit of Measure:

lb Brand: Allbrand

Package Number

A B C D E

If Error Exceeds MAV = Fail

F G

Labeled 

Net

Weight

Package

Gross

Weight

Package

Tare

Weight

Actual 

Package 

Net

Weight

B – C =

Package 

Error

D – A =

Purged Net Wt

Weight of Drained 

Chitterlings (or 

Purged Liquid) and 

Drain Pan − Drain 

Pan Tare =

Purge %

(A – F) × 100

A

1 5 lb 5.130 0.032 5.098 0.098 4.19 16.2 %

2 5.160 0.033 5.127 0.127 4.21 15.8 %

3 5.012 0.032 4.980 − 0.020 4.17 16.6 %

4 5.170 0.034 5.136 0.136 4.20 16.0 %

5 5.020 0.033 4.987 − 0.013 4.18 16.4 %

6 5.102 0.032 5.070 0.070 4.22 15.6 %

7 5.051 0.033 5.018 0.018 4.24 15.2 %

8 5.116 0.032 5.084 0.084 4.20 16.0 %

9 5.120 0.034 5.086 0.086 4.19 16.2 %

10 5.023 0.032 4.991 − 0.009 4.20 16.0 %

11 5.122 0.032 5.090 0.090 4.26 14.8 %

12 5.020 0.033 4.987 − 0.013 4.18 16.4 %

Number of Unreasonable 

Errors Allowed: NONE

Table 2-9. MAV: 0.0.094 lb

E1 − Total Error: 0.054 lb G1 − Total Purge: 191.2 %

E2 – Average Error: 0.0045 lb

(E1 ÷ n = )

G2 – Average Purge: 15.9

(G1 ÷ n = ) %

G3 – Adjusted Average Purge: (G2 – Purge Sample Error Limit [PSEL] = ) %

NET WEIGHT COMPLIANCE: (1) If any of the minus package errors (see Column E) exceed the MAV, the sample fails. (2) If none exceeds 

the MAV and the Average Error (E2) is a positive number, the sample passes. (3) If the Average Error (E2) is a minus number, calculate the 

sample standard deviation and enter it below. (4) Use the Sample Correction Factor (SCF) to calculate the Sample Error Limit (SEL). (5) 

Disregarding the signs, (a) if the Average Error (E2) is larger than the SEL, the sample fails or (b) if the Average Error is less than the SEL the 

sample passes. 

Standard Deviation: 0.0601 × 0.635 (SCF) = 0.0382 (SEL)  Passed  Failed

PURGE COMPLIANCE: MAVs are not applied in the purge test (1) If the Average Purge Error (G2) is less than or equal to 20 %, the sample 

passes. (2) If the Average Purge Error is greater than 20 %, calculate the sample standard deviation and enter it below. (3) Use the Sample 

Correction Factor (SCF) to calculate the Purge Sample Error Limit (PSEL) in percent. (4) Subtract the PSEL from the Average Purge (G2) to 

obtain an Adjusted Average Purge (AAP) and enter that value in G3. (5)(a) If the AAP (G3) is greater than 20 %, the sample fails or (b) if the 

AAP (G3) is 20 % or less, the sample passes.

Standard Deviation: 2.420 × 0.635 (SCF) = 1.536 (PSEL) Purge (G3) 18.83 %  Passed  Failed 

Sample Disposition: Lot passes on both criteria.
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Inspector: 

Chitterlings Worksheet – Category B

Date: (For Use Inside a USDA Inspected Packing Plant Net Weight & Purge Determination)

Packer: Lot Code: Drain Pan Tare: Unit of Measure:

Brand: 

Package Number

A B C D E

IF 

ERROR Exceeds 

MAV

=

FAIL

F G

Labeled 

Net

Weight

Package

Gross

Weight

Package

Tare

Weight

Actual

Package

Net

Weight

B – C =

Package 

Error

D – A =

Purged Net Wt

Drained 

Chitterlings (or 

Purged Liquid) 

and Pan − Drain 

Pan Tare =

Purge %

(A – F) × 100

 A

1 %

2 %

3 %

4 %

5 %

6 %

7 %

8 %

9 %

10 %

Number of Unreasonable 

Errors Allowed: NONE

Table 2-9. MAV:

E1 – Total Error: G1 –Total Purge: %

E2 – Average Error:

(E1 ÷ n = )

G2 – Average Purge: 

(G1 ÷ n = ) %

NET WEIGHT COMPLIANCE: (1) If any of the minus package errors (see Column E) exceed the MAV the sample fails. (2) If 

none of the package errors exceeds the MAV and the Average Error (E2) is a positive number the sample passes. (3) If the Average 

Error (E2) is a minus number the sample fails.

 Passed  Failed 

PURGE COMPLIANCE: MAVs are not applied in the purge test (1) If the Average Purge Error (G2) is less than or equal to 

20 %, the sample passes. (2) If the Average Purge Error (G2) is greater than 20 %, the sample fails. 

Purge:  Passed  Failed

Sample Disposition:
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3-2023

Inspector: 

S. Inspector Chitterlings Worksheet – Category B – Example

Date: (for use Inside a USDA Inspected Packing Plant Net Weight & Purge Determinations)

July 14, 2016

Packer:

Packer Inc.

1000 Roadway 

PackingTown, USA

Lot Code: A34526 Drain Pan Tare:

 0.997 lb

Unit of Measure:

 lb

Brand: 

Allbrand

Package Number

A B C D E

If Error Exceeds MAV = Fail

F G

Labeled 

Net

Weight

Package

Gross

Weight

Package

Tare

Weight

Actual

Package

Net

Weight

B – C =

Package 

Error

D – A =

Purged Net Wt

Drained 

Chitterlings 

(or Purged 

Liquid) and Pan −

Drain Pan Tare =

Purge %

(A – F) × 100

A

1 5 5.130 0.032 5.098 0.098 4.19 16.2 %

2 5.160 0.033 5.127 0.127 4.21 15.8 %

3 5.012 0.032 4.980 − 0.020 4.17 16.6 %

4 5.170 0.034 5.136 0.136 4.20 16.0 %

5 5.020 0.033 4.987 − 0.013 4.18 16.4 %

6 5.102 0.032 5.070 0.070 4.22 15.6 %

7 5.051 0.033 5.018 0.018 4.24 15.2 %

8 5.116 0.032 5.084 0.084 4.20 16.0 %

9 5.120 0.034 5.086 0.086 4.19 16.2 %

10 5.023 0.032 4.991 − 0.009 4.20 16.0 %

Number of Unreasonable 

Errors Allowed: NONE

Table 2-9. MAV: 0.094 lb

E1 – Total Error 0.057 lb G1 –Total Purge: 160 %

E2 – Average Error 0.057 lb

(E1 ÷ n = )

G2 – Average Purge: 16

(G1 ÷ n = ) %

NET WEIGHT COMPLIANCE: (1) If any of the minus package errors (see Column E) exceed the MAV the sample fails. 

(2) If none of the package errors exceeds the MAV and the Average Error (E2) is a positive number the sample passes. (3) If 

the Average Error (E2) is a minus number the sample fails.

 Passed  Failed 

PURGE COMPLIANCE: MAVs are not applied in the purge test (1) If the Average Purge Error (G2) is less than or equal to 

20 %, the sample passes. (2) If the Average Purge Error (G2) is greater than 20 %, the sample fails. 

Purge:  Passed  Failed

Sample Disposition:
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3-2023

Date: Peat Moss Labeled by Volume Package Worksheet – Dimensional Procedure

Labeled Quantity Converted 

to Metric:

Largest Quantity: Manufacturer: 

Product: 

Lot Size: Sample Size: Lot Code: Plant Number:

1 cubic foot = 1728 cu in *Total Volume (cubic feet) = L × W × H ÷ 1728 or *Total Volume (L)

(cubic meter) = L × W × H ÷ 1 000 000

Dimensions Measured in:  mm  in Package Error in:  mL  cu in

Length Avg Width Avg Height Avg Total*

1.

2. 

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

Step 1. What is the MAV for this labeled quantity in Table 2-6? 

 __________ mL  __________ cu in 

Total Package Error:

Step 2. How many minus errors exceed the MAV _______? If the number of unreasonable errors 

exceeds the number permitted for the sample size in Table 2-1., the sample fails; go to Step 7. If there 

are no Unreasonable Errors, sum the package errors, and calculate the Average Error entering it in 

Step 3. Go to Step 4.

Step 3: Average Package Error:

Step 4. If the Average Error is zero or a positive number, the sample passes; go to Step 7. If the 

Average Error is a negative number, go to Step 5.

Step 5. Calculate the Sample Standard Deviation (s) and multiply (s) by the Sample Correction Factor 

(SCF) for the sample size to obtain the Sample Error Limit (SEL); go to Step 6.

(s)______________ × (SCF) ___________ = SEL ________________

Box 6. Disregarding the signs, is the 

SEL in Step 5 larger than the Average 

Package Error in Step 3? If yes, the 

sample passes, go to Step 7 and approve 

the lot. If no, the sample fails, go to 

Step 7 and reject the lot.

Step 7. Action Taken:  Lot Rejected  Lot Approved

Random Numbers: Enter the numbers as you select them in the top row and reorder them in the bottom row.
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3-2023

Date:

Borax Audit Worksheet

Use only IF the sample fails the net weight test. Use the lightest package in the sample. Inspector:

Product: Lot Code:

Declared Net Weight on the Package:

Declared Volume on the Borax Package:

Gross Weight of Package:

Tare Weight of Package:

Net Weight of Package:

Volume of Dry Measure – Look up the volume of the dry measure in milliliters used to calculate the 

volume and enter it below:

= mL

Dry Measure: Dry Pint = 550.6 mL; Dry Quart = 1101 mL; Liter = 1000 mL

Empty Weight of Dry Measure:

Gross Weight of Dry Measure + Borax:

Net Weight of Borax in the Dry Measure:

(Box 10 – Box 9) = 

Net Volume of Borax:

(Box 7 ÷ Box 11) × Box 8 =

Refer to Step 10 to determine if the sample is in compliance or if further action is required.

(Added 2016)
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3-2023

Softwood Lumber Worksheet

MAV for Packages Labeled by Length, Width, or Area (Table 2-8)

(Note: Lumber of a predetermined dimension as defined by NIST Handbook 130, Uniform Packaging and Labeling 

Regulations). 

• 1 m (1 yd) or less in 3 % of labeled quantity.

• More than 1 m (1 yd) to 43 m (48 yd) is 1.5 % of labeled quantity.

Section 1. Compliance with Maximum Allowable Variation 

1. Calculate the MAV for labeled thickness = _______. Do any of the minus errors for thickness exceed the MAV?

□ Yes, go to Section 5. □ No, go to Section 2

2. Calculate the MAV for length = ______________. Do any of the minus errors for width exceed the MAV?

□ Yes, go to Section 5. □ No, go to Section 3

3. Calculate the MAV for labeled width = ________. Do any of the minus errors for length exceed the MAV?

□ Yes, go to Section 5. □ No, go to Section 4

Section 2. Compliance with the Average Requirement – Thickness 

4. Calculate the Average Error for labeled thickness _______. The sample passes this requirement if the Average 

Error is zero or a positive number. Go to Section 3. If the Average Error is a negative number, go to Step 5.

5. Calculate the Sample Standard Deviation (s) and multiply (s) by the Sample Correction Factor (SCF) for the sample 

size to obtain the Sample Error Limit (SEL). Go to Step 6.

(s)______________ × (SCF) ___________ = SEL ________________

6. Disregarding the signs, is the SEL in Step 5 larger than the Average Error in Step 4? If yes, the lot passes on 

thickness. If no, go to Section 3.

Section 3. Compliance with the Average Requirement – Length 

7. Calculate the Average Error for labeled length_______. The sample passes this requirement if the Average Error 

is zero or a positive number. Go to Section 4. If the Average Error is a negative number, go to Step 8.

8. Calculate the Sample Standard Deviation (s) and multiply (s) by the Sample Correction Factor (SCF) for the sample 

size to obtain the Sample Error Limit (SEL). Go to Step 9.

(s)______________ × (SCF) ___________ = SEL ________________

9. Disregarding the signs, is the SEL in Step 8 larger than the Average Error in Step 7? If yes, the lot passes on 

length. If no, go to Section 4.
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3-2023

Section 4. Compliance with the Average Requirement – Width

10. Calculate the Average Error for labeled width_. The sample passes this requirement if the Average Error is zero 

or a positive number. Go to Section 6. If the Average Error is a negative number, go to Step 11.

11. Calculate the Sample Standard Deviation (s) and multiply (s) by the Sample Correction Factor (SCF) for the sample 

size to obtain the Sample Error Limit (SEL). Go to Step 12.

(s)______________ × (SCF) ___________ = SEL ________________

12. Disregarding the signs, is the SEL in Step 11 larger than the Average Error in Step 10? 

□ Yes, approve the lot. □ No, go to Section 5

Section 5. Determine Moisture Shrinkage Allowance

If the average error for any thickness or width measurement is a minus value, or if the MAV is exceeded, perform a 

moisture test on each piece to determine if a moisture shrinkage allowance should be applied. Apply the appropriate 

allowance to each piece, then re-calculate the average error and re-determine compliance with the MAV. If the average 

error is a minus value for any length measurement, or if the MAV is exceeded for any length measurement the lot fails. 

No moisture shrinkage allowance is applied to length. 

Piece 

Number Moisture Content

Moisture 

Shrinkage 

Allowance

Piece 

Number Moisture Content

Moisture 

Shrinkage 

Allowance

1. 7.

2. 8.

3. 9.

4. 10.

5. 11.

6. 12.

Section 6. Action Taken: □ Lot Rejected □ Lot Approved

Comments: Official Name/Signature:

Date:

Random Numbers: Enter the numbers as you select them in the top row and reorder them in the bottom row.

1/2020
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Softwood Lumber Worksheet

Product: Mill Number and Agency:

Labeled Dimensions: Address: City/State/Zip:

Length: 

Width: Brand/Grade/Surface: Testing Location:

Thickness: 

Piece 

Number

Average

Length

Average

Width

Average

Thickness

Piece

Number

Average

Length

Average

Width

Average

Thickness

1. 7.

Error: Error:

2. 8.

Error: Error:

3. 9.

Error: Error:

4. 10.

Error: Error:

5. 11.

Error: Error:

6. 12.

Error: Error:

Total 

Average:

Average 

Error:

Rev. 01/2020
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Structural Plywood Sheets and Wood-Based Structural Panels Worksheet

MAV for Packages Labeled by Length, Width, or Area (Table 2-8)

(Note: Structural Plywood Sheets or Wood-Based Structural Panels of a predetermined dimension is considered a 

“package” as defined by NIST Handbook 130, Uniform Packaging and Labeling Regulations). 

• 1 m (1 yd) or less in 3 % of labeled quantity.

• More than 1 m (1 yd) to 43 m (48 yd) is 1.5 % of labeled quantity.

Section 1. Compliance with Maximum Allowable Variation 

1. Calculate the MAV for labeled thickness = _______. Do any of the minus errors for thickness exceed the MAV? 

□ Yes, go to Section 5. □ No, go to Section 2

2. Calculate the MAV for length = ______________. Do any of the minus errors for width exceed the MAV?

□ Yes, go to Section 5. □ No, go to Section 3

3. Calculate the MAV for labeled width = ________. Do any of the minus errors for length exceed the MAV?

□ Yes, go to Section 5. □ No, go to Section 4

Section 2. Compliance with the Average Requirement – Thickness 

4. Calculate the Average Error for labeled thickness _______. The sample passes this requirement if the Average Error 

is zero or a positive number. Go to Section 3. If the Average Error is a negative number, go to Step 5.

5. Calculate the Sample Standard Deviation (s) and multiply (s) by the Sample Correction Factor (SCF) for the sample 

size to obtain the Sample Error Limit (SEL). Go to Step 6.

(s)______________ × (SCF) ___________ = SEL ________________

6. Disregarding the signs, is the SEL in Step 5 larger than the Average Error in Step 4? If yes, the lot passes on 

thickness. If no, go to Section 3.

Section 3. Compliance with the Average Requirement – Length 

7. Calculate the Average Error for labeled length_______. The sample passes this requirement if the Average Error is 

zero or a positive number. Go to Section 4. If the Average Error is a negative number, go to Step 8.

8. Calculate the Sample Standard Deviation (s) and multiply (s) by the Sample Correction Factor (SCF) for the sample 

size to obtain the Sample Error Limit (SEL). Go to Step 9.

(s)______________ × (SCF) ___________ = SEL ________________

9. Disregarding the signs, is the SEL in Step 8 larger than the Average Error in Step 7? If yes, the lot passes on length. 

If no, go to Section 4.
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Structural Plywood Sheets and Wood-Based Structural Panels Worksheet

Section 4. Compliance with the Average Requirement – Width

10. Calculate the Average Error for labeled width _______. The sample passes this requirement if the Average Error is 

zero or a positive number. Go to Section 6. If the Average Error is a negative number, go to Step 11.

11. Calculate the Sample Standard Deviation (s) and multiply (s) by the Sample Correction Factor (SCF) for the sample 

size to obtain the Sample Error Limit (SEL). Go to Step 12.

(s)______________ × (SCF) ___________ = SEL ________________

12. Disregarding the signs, is the SEL in Step 11 larger than the Average Error in Step 10? If yes, approve the lot. 

□ Yes, approve the lot. □ No, go to Section 5

Section 5. Determine Moisture Shrinkage Allowance

If the average error for any dimension (thickness, length, width) is a minus value, or if the MAV is exceeded for any piece, 

perform a moisture test on each piece to determine if a shrinkage allowance should be applied. Apply the appropriate 

allowance to each piece, then re-calculate the average error and re-determine compliance with the MAV.

Piece 

Number

Moisture 

Content

Moisture 

Shrinkage 

Allowance

Piece 

Number

Moisture 

Content

Moisture 

Shrinkage 

Allowance

1. 7.

2. 8.

3. 9.

4. 10.

5. 11.

6. 12.

Section 6. Action Taken: □ Lot Rejected □ Lot Approved

Comments: Official Name/Signature:

Date:

Random Numbers: Enter the numbers as you select them in the top row and reorder them in the bottom row.

(Rev. 01/2020)
Handbook 133 – 2023 Appendix C. Model Inspection Report Forms

209

This publication is available free of charge from: https://doi.org/10.6028/NIST.HB.13

3-2023

Structural Plywood Sheets and Wood-Based Structural Panels Worksheet

Product: Mill Number and Agency:

Labeled Dimensions: Address: City/State/Zip:

Length: 

Width: Brand/Grade/Surface: Testing Location:

Thickness: 

Piece 

Number

Average

Length

Average

Width

Average

Thickness

Piece

Number

Average

Length

Average

Width

Average

Thickness

1. 7.

Error: Error:

2. 8.

Error: Error:

3. 9.

Error: Error:

4. 10.

Error: Error:

5. 11.

Error: Error:

6. 12.

Error: Error:

Total 

Average:

Average 

Error:
Appendix C. Model Inspection Report Forms Handbook 133 – 2023

210

This publication is available free of charge from: https://doi.org/10.6028/NIST.HB.13

3-2023

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