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  1. Office of Training Education and Development (OTED)

Audit Results Summary form

Level I Food Safety Inspection Officer (State, Local, Tribal)
Audit Results Summary Form

Posted: April 26, 2007

Original to Candidate
Copies to Department’s Director and Candidate’s Supervisor

Candidate’s Name:


Candidate’s Work E-mail Address:

Audit Number: 1. 2. 3.

Performance Auditor:

(printed name)________________

Date of Decision: ___/___/___


Candidate’s Supervisor: ________________________

Specific Elements Failed:

Element # Rationale

Continue on additional page if necessary

Department’s Director’s verification that all training prerequisites were met and concurrence that the inspector has achieved Level I. Please attach a copy of the employee’s completed ORA U Training Curriculum (Bingo Card) which should be signed off by the employee’s immediate supervisor.

Dept. Director’s name
Signature and Date
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