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Report Number:


Factory name:


Official Contact:


Person Interviewed:

Reason for Survey:
Initial Audit
Follow-up Audit
In-Production Audit
Unannounced Audit
Other (Please Specify)

Conclusions:
Pass
Conditional Acceptance -- only pending timely corrective action requested in the following pages
Fail

If re-audit required, specify date scheduled:

Surveyed by: Title: Date:

Evaluated by: Date:

Approved by: Date:

Executive Summary:




Compliance with the following sections is necessary for conformance with the ICTI Code of Business Practices and is determined using Appendix II, the Audit Checklist.

Conformance is expected in the shortest time practicable; exceptions are in cases of life threatening or abusive situations, which should be immediately corrected.

Section	Acceptable	If NO, detail Corrective Action requested (attach additional pages if necessary)	Priority Code*
1. General	YES NO
2. Working Hours	YES NO
3. Wages and Compensation Services	YES NO
4. Underage Labor	YES NO
5a. Forced Labor	YES NO
5b. Prison Labor	YES NO
6 Disciplinary Practices	YES NO
7. Discrimination	YES NO
8. Employee Representation	YES NO
9. Facilities	YES NO
10. Fire Protection	YES NO
11a. General Environmental Health and Safety (EHS)	YES NO
11b. Health and Safety	YES NO
11c. Environmental	YES NO
12a. Welfare - Dormitories	YES NO
12b. Welfare - Canteen/Cafeteria Services	YES NO
12c. Welfare - Medical	YES NO

NOTE: This document is to be used in conjunction with:

Code of Business Practices

Appendix I:   Methodology for Evaluating Compliance

Appendix II:  Audit Checklist

Appendix IIa:  Guidance Document

Appendix III: Corrective Action Plan