Self-Assessment Log

SELF-ASSESSMENT LOG

RECOGNITION PROGRAM
AGENCY: / FOR COMMISSION COMMENTS:
ASSESSOR'S NAME______
DATE: ______INITIALS______
COMMENTS:
STANDARD
NUMBER / Level of Compliance /

MANDATORY

/ NOT APPLICABLE /

FOR ASSESSOR USE ONLY

COMPLIANCE / WAIVER / COMPLIANCE /

NON COMPLIANCE

1.1.1 / M
1.1.2 / M
1.2.3 / M
1.2.4 / M
1.2.5 / M
1.2.8 / M
1.2.9 / M
1.3.1 / M
1.3.2 / M
1.3.3 / M
1.3.4 / M
1.3.5 / M
1.3.6 / M
1.3.7 / M
1.3.8 / M
1.3.9 / M
1.3.10 / M
1.3.11 / M
11.1.1 / M
12.1.2 / M
12.2.1 / M
16.3.1 / M
16.3.2 / M
16.3.3 / M
16.3.6 / M
16.4.2 / M
17.4.2 / M
17.5.3 / M
22.2.2 / M
22.2.4 / M
22.3.4 / M
26.1.1 / M
26.1.3 / M
26.1.4 / M
26.1.6 / M
31.2.1 / M
31.2.2 / M
32.1.1 / M
32.2.1 / M
32.2.7 / M
32.2.8 / M
33.1.5 / M
33.1.6 / M
33.1.7 / M
33.4.1 / M
33.4.3 / M
33.5.1 / M
33.6.2 / M
33.8.2 / M

(CONTINUED ON NEXT PAGE)

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SELF-ASSESSMENT LOG

RECOGNITION PROGRAM
AGENCY: / FOR COMMISSION COMMENTS:
ASSESSOR'S NAME______
DATE: ______INITIALS______
COMMENTS:
STANDARD
NUMBER / Level of Compliance /

MANDATORY

/ NOT APPLICABLE /

FOR ASSESSOR USE ONLY

COMPLIANCE / WAIVER / COMPLIANCE /

NON COMPLIANCE

34.1.3 / M
35.1.1 / M
35.1.2 / M
41.2.1 / M
41.2.2 / M
41.2.3 / M
41.2.5 / M
41.2.6 / M
41.2.7 / M
41.3.5 / M
41.3.6 / M
42.1.3 / M
42.2.7 / M
42.2.10 / M
43.1.1 / M
43.1.5 / M
44.2.2 / M
44.2.3 / M
46.1.2 / M
46.1.3 / M
46.1.4 / M
46.1.5 / M
46.1.6 / M
46.1.7 / M
46.3.4 / M
52.1.1 / M
52.1.2 / M
54.1.3 / M
61.1.2 / M
61.1.3 / M
61.1.5 / M
61.1.7 / M
61.3.2 / M
70.1.1 / M
70.1.2 / M
70.2.1 / M
70.4.2 / M
71.1.1 / M
71.2.1 / M
71.3.1 / M
71.3.3 / M
71.4.2 / M
71.4.3 / M
71.5.1 / M
81.2.1 / M
81.2.2 / M
81.2.3 / M
81.2.4 / M
81.2.8 / M
81.2.12 / M
81.2.15 / M
81.3.2 / M
82.1.1 / M
82.1.6 / M
83.1.1 / M
83.2.1 / M
83.3.2 / M
84.1.1 / M
84.1.2 / M
84.1.3 / M
84.1.4 / M
84.1.6 / M
(1) / (2) / (3) / (4) / (5) / (6) / (7)
112 / _____ / _____ / _____ / _____ / _____ / _____

(PLEASE ADD EACH COLUMN AND PLACE TOTAL ON THE LINE BENEATH THE COLUMN NUMBER.)

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Revised July 2008