1 Surveillance visit	
Surveillance body
(name and address)	     	
Surveillance visit report no.	     	
Assessor	     	
Date of the surveillance visit	     	
Summary	 no notes, recommendations and/or non-conformities
 notes, recommendations and/or minor non-conformities
 serious and/or safety-relevant non-conformities	
Attachments	 surveillance protocol/s (number of protocols:      )	
	 non-conformity report	
	 separate photographic documentation	
	 approvals and related test reports and technical drawings for those design type approvals issued by a foreign competent authority, which were used by the assessor to check for design type conformity during this surveillance visit	
	 others; short description:      	
2 Company	
Name	     	
Address	     	
Identification mark issued by BAM	     	
Types of dangerous goods packagings sorted by country and approval issuing authority e.g. “NL: 4A, 31A, A/ofi: 3H1”, excluding BAM UN approvals	     	
Comment:      	
3 Availability of dangerous goods regulations	
Are the ADR, BAM-GGR 001 (incl. Annex 1) and the national dangerous goods regulations and laws available/accessible in their latest revision within the company?	 no	 yes	Note:
National legal regulations need to be considered. For instance, if national legal regulations require the use of UN approvals issued by the national competent authority this may imply that a production based on BAM UN approvals is not permitted. For the recognition of the quality assurance program by BAM the requirements of BAM-GGR 001 need to be fulfilled regardless of national regulations.	
4 Personnel	
Representative of the company
(incl. email address and telephone number)	     	
Deputy/s, if applicable	     	
Contact person for BAM, if applicable
(incl. email address)	     	
Changes since last surveillance visit	     	
Comment:      	
5 Documentation of serious and safety-relevant non-conformities	Were there any recalls or complaints due to serious or safety-relevant non-conformities on dangerous goods packagings since the last surveillance visit?	 yes	 no	If “yes”: Was BAM informed in case of any of such recall and complaint?	 no	 yes	Comment:      	6 Additional notes by the surveillance assessor
(e.g. activities and tests, which were not reviewed, additionally reviewed aspects of the QAP, training of a new inspector)	     	
7 Signature
The statements given in the surveillance visit documents (report, protocol/s) are confirmed by	     		     		Place/Date	Signature surveillance assessor	Place/Date	Signature representative of the company