HLA / SCOPE VERIFICATION and ACCEPTANCE TEMPLATE

Project Name	[Insert Project Name]	Date	[Insert Today's Date]
Deliverable(s)	[Insert Deliverable Completed]
Inspection Results	[Insert Results of Deliverable Inspection]
The above inspection fully met the deliverable(s) specified in this project’s Scope Statement.
Executive Approval(s)
Stakeholder Approval(s)
Stakeholder Approval(s)
Stakeholder Approval(s)
Stakeholder Approval(s)

HLA / SCOPE VERIFICATION and ACCEPTANCE FORM INSTRUCTIONS

The HLA / Scope Verification document identifies that the project team has formal acceptance for a project deliverable. The team members are required to inspect the deliverable and specify the inspection results. A signature of each member of the project team is required as evidence that they inspected the deliverable and agreed to the acceptance of the project’s deliverable and product. This acceptance can occur several times, once for each major deliverable.

Frequent inspection of the product or major deliverables of the project is performed to ensure that the team is performing the work that will lead to the accurate completion of the Scope. These inspections are often called audits, product verifications or reviews. They are performed by the project manager(s), team members, executives, and people independent of the project.

Project Name – Specify the name of the project.

Date – Insert today’s date.

Deliverable(s) – Specify the deliverable(s) that have been inspected for completion. The deliverable(s) should correspond directly to the Scope Statement or updates to the Scope.

Inspection Results – Specify how the deliverable(s) were inspected and the final results. This should be a prescribed procedure or a checklist which has been developed in advance. The team is not just examining the deliverable but comparing what has actually been produced versus what was supposed to produce, in terms of precise characteristics and specifications.

Approvals – Identify the appropriate names for approvals and obtain written signatures.

SCOPE VERIFICATION and ACCEPTANCE EXAMPLE

Project Name	Electronic Medical Record Evaluation Project	Date	09/15/05
Deliverable(s)	Operational Workflow Diagrams for Each Department (Scheduling to Check-Out Process)
Inspection Results	Final Operational Workflow Diagrams (/projects/EMR/operational workflow diagrams dept …) were completed for each FPP Department. The areas of review (…..) were agreed upon in advanced by the project team. Each area was successfully reviewed and documented in flowchart diagrams. Every Operational Workflow Diagrams for each area was reviewed with the department and signed off by the departments’ representative on the project team as complete and accurate. See IS&T Project Manager’s EMR Evaluation Project Folder for department signatures.
The above inspection fully met the deliverable(s) specified in this project’s Scope Statement.
Executive Approval(s)	Dean Miska
Stakeholder Approval(s)	Lori Smith
Stakeholder Approval(s)	Ave Marie Gallo
Stakeholder Approval(s)	Sheila Plungis
Stakeholder Approval(s)	Jamille Crawford