For Comments template e

							         Health   Santé
         Canada   Canada




Comment Recording Form_en   Page 1 of 3
                                                            Health Products and Food Branch Inspectorate
                                                                     Comment Recording Form

Privacy Act: In the event that a Health Canada representative needs to contact you to clarify any of your comments, you are ask to include your name, telephone number, full mailing
or email address. The personal information provided in this form is protected under the Privacy Act. If you choose to provide personal information, it will not be shared with other
parties and will not be used for any purpose other that the ones listed above. Please note that you can contact us at any time to correct your personal information.


INSTRUCTIONS:
   1. Complete the requested contact information.
   2. Record the draft “for comment” document title.
   3. Record the line number from the PDF document which corresponds to the area where a change is proposed.
   4. Record the nature of the proposed change: Editorial (E) or Technical (T).
   5. Record your comment and the rationale for your comment.
   6. Record your proposed revised text.

             Please submitted your comments before the end of the document’s “For Comment” period, in order to have them considered in the document’s final review.

1. CONTACT INFORMATION:
Comments submitted by:
Address:
Daytime telephone number:
Date of submission:


2. DRAFT “FOR COMMENT” DOCUMENT TITLE:_________________________________________________________________________________




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1. Comment provider’s full name: __ _____________________________________________________________Submission: _______________________
2. DRAFT “FOR COMMENT” DOCUMENT TITLE:_ __ _____________________________________________________________
* Please use the Adobe (PDF) version of the document, to ensure accuracy in line numbers.
Comment      3. Line number 4. Editorial (E)       5. Comment and rationale                 6. Proposed revised text                     Decision (& date)
Number       in PDF                or
             Document*      Technical (T)                                                                                              (For internal use only)
                            Comment
     1
     2
     3
     4
     5
     6
     7
     8
     9
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    12
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Comment Recording Form_may2009_v1

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