This is a ready-to-use form. Replace every <<FILL: ...>> placeholder with your own specifics, set your document numbers and dates, and route it through your normal document control, review, and approval. A worked filled specimen follows the template so you can see how a completed version reads. Verify each cited regulation against the current published source before you rely on it, and treat this as an educational reference to adapt rather than as legal or regulatory advice.
One form covers one authorization to re-execute. It is completed and approved before the re-execution runs, never after. The governing process sits in SOP: Validation Test Incident Management.
Why this form exists
Re-running a failed test is the single most scrutinized action in validation execution. A legitimate re-test and testing into compliance look identical in the final result: both end in a PASS. What separates them is what was known and approved beforehand. This form is the record of what was known beforehand.
If a reviewer asks “why were you allowed to run this again?”, this form is the answer.
Form control header
| Field | Entry |
|---|---|
| Form title | Validation Retest / Re-execution Authorization |
| Authorization number | <<FILL: RTA-ID, e.g. RTA-OQ-LIMS-009>> |
| Form template number and version | <<FILL: FRM-ID and version>> |
| Date raised | <<FILL: date>> |
| Raised by (name, role) | <<FILL>> |
| Validation project | <<FILL: project name and number>> |
| Status | Draft / Approved / Executed / Void |
Field table
Complete every required field. Where a field is not applicable, write N/A with a reason. Do not leave a required field blank.
| # | Field | Format | Required | Who completes | When |
|---|---|---|---|---|---|
| 1 | Authorization number | Text, per local numbering scheme | Yes | Validation lead | On raising |
| 2 | Test incident number | Text, links to the test incident log | Yes | Validation lead | On raising |
| 3 | QMS deviation number | Text, or N/A with reason | Conditional (required for classes C3 to C6) | Validation lead | On raising |
| 4 | Incident classification | Controlled list, C1 to C6 | Yes | QA (confirmed) | Before approval |
| 5 | Protocol number, title, version | Text | Yes | Validation lead | On raising |
| 6 | Validation phase | Controlled list: DQ / IQ / OQ / PQ / UAT / method validation / process validation / cleaning validation | Yes | Validation lead | On raising |
| 7 | Original failed test case and step | Text | Yes | Validation lead | On raising |
| 8 | Original failure date and time | Date and 24-hour time | Yes | Validation lead | On raising |
| 9 | Original failed record reference | Text, page or record identifier | Yes | Validation lead | On raising |
| 10 | Verified root cause statement | Free text, specific and evidenced | Yes | Validation lead or SME | Before approval |
| 11 | Root cause evidence reference | Text, attachment identifiers | Yes | Validation lead or SME | Before approval |
| 12 | Corrective action taken | Free text | Yes | Validation lead or SME | Before approval |
| 13 | Change control reference | Text, or N/A with reason | Conditional (required where a controlled item changed) | Validation lead | Before approval |
| 14 | Corrective action completion date | Date | Yes | Implementer | On completion |
| 15 | Corrective action verified by (independent) | Name, role, date, signature | Yes | A person other than the implementer | On verification |
| 16 | Scope and impact assessment reference | Text, or N/A with reason | Conditional (required for classes C3 to C6) | Validation lead | Before approval |
| 17 | Re-test scope: primary | Test case and step list | Yes | Validation lead | Before approval |
| 18 | Re-test scope: regression | Test case list, or “none” with justification | Yes | Validation lead | Before approval |
| 19 | Scope justification | Free text | Yes | Validation lead | Before approval |
| 20 | Environment or instance | Text | Yes | Validation lead | Before approval |
| 21 | Build, version, or firmware | Text, exact version string | Yes | Validation lead | Before approval |
| 22 | Configuration set or recipe reference | Text | Yes | Validation lead | Before approval |
| 23 | Test data set reference | Text | Yes | Validation lead | Before approval |
| 24 | Acceptance criterion for the re-test | Text, quoted from the approved protocol | Yes | Validation lead | Before approval |
| 25 | Testing-into-compliance attestation | Signed statement | Yes | Validation lead | Before approval |
| 26 | Approvals | Names, signatures, dates | Yes | Per the tier table | Before execution |
| 27 | Re-execution record reference | Text | Yes | Executor | After execution |
| 28 | Re-execution result | Controlled list: Pass / Fail | Yes | Executor | After execution |
| 29 | New incident number if the re-test failed | Text, or N/A | Conditional | Validation lead | After execution |
| 30 | Closure confirmation | Name, signature, date | Yes | QA for classes C4 to C6, validation lead for C1 to C3 | On closure |
1. Incident reference and context
| Field | Entry |
|---|---|
| Test incident number | <<FILL: TI number>> |
| QMS deviation number | <<FILL: deviation number, or N/A with reason>> |
| Incident classification (QA confirmed) | C1 test script error / C2 execution error / C3 environment, build or test data / C4 defect, low GxP impact / C5 defect, high GxP impact / C6 data integrity event |
| Protocol number, title, version | <<FILL>> |
| Validation phase | <<FILL>> |
| System, equipment, method, or process | <<FILL>> |
| Original failed test case and step | <<FILL>> |
| Original failure date and time | <<FILL>> |
| Original failed record reference | <<FILL: execution page or record ID, which remains in the package marked FAIL>> |
| Number of prior re-execution attempts on this step | <<FILL: 0, 1, 2 ...>> |
If prior attempts exist, state each attempt reference and result. Where the attempt count reaches the limit set in your procedure, this form is not the right route; escalate instead.
2. Verified root cause
A re-test is authorized on the strength of a known cause. An unknown cause means the re-test would only be an experiment to see whether the failure recurs, which is not an authorized activity under this form.
| Field | Entry |
|---|---|
| Root cause statement | <<FILL: the specific, verified cause. Name the parameter, the code path, the step, the setting, or the condition>> |
| Investigation method used | <<FILL: e.g. five-whys, fishbone, configuration comparison, log review, code review>> |
| Evidence confirming the cause | <<FILL: attachment identifiers and what each shows>> |
| Was the cause reproduced or otherwise confirmed? | Yes, how: <<FILL>> / No, why the cause is nonetheless verified: <<FILL>> |
| Root cause accepted by | <<FILL: name, role, date, per the authority matrix in your procedure>> |
A statement that restates the symptom is not acceptable here. “The report printed a blank batch number” is the symptom. “The report template referenced field BATCH_ID_EXT, which is only populated for externally manufactured lots, instead of BATCH_ID” is a cause.
3. Corrective action, completed and independently verified
| Field | Entry |
|---|---|
| Corrective action description | <<FILL: exactly what was changed, by whom>> |
| Type of change | Software fix / Configuration change / Equipment repair or adjustment / Method or recipe correction / Protocol correction or addendum / Test data correction / Environment restoration / Training or procedure change / Other <<FILL>> |
| Change control reference | <<FILL: CR number, or N/A with reason>> |
| Protocol addendum reference (if the protocol changed) | <<FILL: addendum number, or N/A>> |
| CAPA reference (if recurrence prevention needed) | <<FILL: CAPA number, or N/A with reason>> |
| Implemented by (name, role, date) | <<FILL>> |
| Completion verified by (name, role, date, signature) | <<FILL: must not be the implementer>> |
| How completion was verified | <<FILL: e.g. configuration export compared against specification; code diff reviewed; calibration certificate reviewed>> |
Gate 3A. If the corrective action is not complete at the time of signing, this form is not approvable. Re-executing “while the fix is being finalized” produces a result that belongs to neither the broken nor the fixed state.
Gate 3B. Verification of completion is performed by someone other than the person who implemented the change. Self-verification of one’s own correction is one of the easiest findings for a reviewer to spot from the signature block alone.
4. Re-test scope and its justification
Scope is where a re-test authorization earns its keep. The failing step is the obvious part. Everything the correction could have disturbed is the part teams under schedule pressure cut.
4.1 Primary scope
| Field | Entry |
|---|---|
| Test cases and steps to re-execute | <<FILL: list every test case and step>> |
| Acceptance criterion, quoted from the approved protocol | <<FILL: quote it exactly. Do not paraphrase and do not restate it in a way that is easier to meet>> |
| Was the acceptance criterion changed as part of this incident? | No / Yes, protocol addendum <<FILL>>, approved by <<FILL>> on <<FILL: date>> |
If the acceptance criterion changed, the change is approved separately at the level that approved the original protocol, with the original text, the corrected text, and the justification recorded. A criterion may not be relaxed in this form.
4.2 Regression scope
Work the prompts below and record an answer for each. The default answer to “should we run regression?” is yes. A “no” needs a reason a reviewer would accept.
| Regression prompt | Answer | Test cases added to scope |
|---|---|---|
| Does the correction touch shared logic, a shared calculation, or a shared library used elsewhere? | Yes / No | <<FILL>> |
| Does it touch a shared configuration object, template, recipe, or master data record? | Yes / No | <<FILL>> |
| Does it touch an interface to or from another system? | Yes / No | <<FILL>> |
| Does it touch a security role, permission set, or workflow routing? | Yes / No | <<FILL>> |
| Does it touch an audit trail, electronic signature, or record-retention behaviour? | Yes / No | <<FILL>> |
| Were any test cases already recorded as PASS while the defective condition was present? | Yes / No | <<FILL: these are re-executed, see the scope and impact assessment>> |
| Did the environment or build change between the original execution and this re-test? | Yes / No | <<FILL>> |
| Does the vendor’s release note for the fix list any other changed component? | Yes / No / N/A | <<FILL>> |
| Field | Entry |
|---|---|
| Regression test cases in scope | <<FILL: full list, or "none">> |
| Regression scope justification | <<FILL: why this set is sufficient, and specifically why anything excluded can be excluded>> |
| Regression waived? | No / Yes, justification <<FILL>>, QA approver <<FILL>> |
4.3 Scope justification statement
<<FILL: two to five sentences explaining the scope. State what the correction touched, what could plausibly have been affected, what is therefore in scope, and what is excluded and why. A reviewer should be able to disagree with the reasoning, which means the reasoning has to be visible.>>
5. Environment and build the re-test will run on
A re-test that runs on a different environment or build than the one intended proves nothing about the intended one. Confirm and record the exact configuration.
| Field | Entry |
|---|---|
| Environment or instance name | <<FILL>> |
| Build, version, or firmware (exact string) | <<FILL>> |
| Environment matches the qualified target environment? | Yes / No, difference and justification <<FILL>> |
| Configuration set, recipe, or method reference | <<FILL>> |
| Test data set reference and its controlled state | <<FILL>> |
| Interfaces active or stubbed | <<FILL: list, and state which are live>> |
| Environment confirmed by (name, role, date) | <<FILL>> |
| Evidence of environment confirmation | <<FILL: e.g. version screen capture, deployment record, configuration export>> |
6. Testing-into-compliance attestation
This is the gate. Read each statement, answer honestly, and sign. A “No” on any statement means the re-execution is not authorized and the form is returned.
| # | Statement | Response |
|---|---|---|
| 1 | The root cause of the original failure is understood and documented, not assumed. | Yes / No |
| 2 | The corrective action is complete and its completion has been independently verified. | Yes / No |
| 3 | This re-test is being run because a specific condition changed, not to see whether the failure recurs. | Yes / No |
| 4 | The acceptance criterion for the re-test is the original approved criterion, or a criterion changed through an approved, justified protocol change that was not made easier to satisfy. | Yes / No |
| 5 | The original failed record remains in the validation package, marked FAIL, and has not been erased, blanked, overwritten, or amended to PASS. | Yes / No |
| 6 | The re-execution will be recorded as a new, separately dated and signed record referencing the incident number. | Yes / No |
| 7 | Every prior re-execution attempt on this step is disclosed in section 1. | Yes / No |
| 8 | The regression scope in section 4.2 was determined by what the correction could affect, not by what time allows. | Yes / No |
Attestation. I confirm that the responses above are accurate, that this re-execution is not being requested in order to obtain a passing result without an understood and corrected cause, and that I am aware that repeated re-execution without a corrected cause constitutes testing into compliance.
| Field | Entry |
|---|---|
| Attested by (name, role) | <<FILL: validation lead or equivalent>> |
| Signature and date | <<FILL>> |
7. Approvals
Approval level rises with GxP impact. No person signs more than one row on the same form, and the executor of the original test does not approve its re-execution.
| Incident classification | Validation lead | System / process owner | Quality Assurance | Higher authority (Quality Head or delegate) |
|---|---|---|---|---|
| C1 test script or expected-result error | Approves | Informed | Notified | Not required |
| C2 execution error | Approves | Informed | Notified | Not required |
| C3 environment, build, or test data issue | Recommends | Informed | Approves | Not required |
| C4 defect, low GxP impact | Recommends | Reviews | Approves | Not required |
| C5 defect, high GxP impact | Recommends | Reviews | Approves | Approves |
| C6 data integrity event | Recommends | Reviews | Approves | Approves |
| Role | Name | Signature | Date |
|---|---|---|---|
| Prepared by (validation lead) | <<FILL>> | ||
| Technical review (SME) | <<FILL>> | ||
| System / process owner | <<FILL>> | ||
| Quality Assurance | <<FILL>> | ||
| Higher authority (required for C5, C6) | <<FILL>> |
Rule. The latest approval date on this form is on or before the re-execution date recorded in section 8. A form approved after the re-execution ran is not an authorization; it is a retrospective justification, and the audit trail will show the order.
8. Re-execution outcome
Completed after the re-execution runs.
| Field | Entry |
|---|---|
| Re-execution record reference | <<FILL: new execution record, addendum, or page identifier>> |
| Executed by (name, role) | <<FILL: may not be the sole approver of this form>> |
| Execution date and time | <<FILL>> |
| Result against the stated acceptance criterion | Pass / Fail |
| Evidence attached | <<FILL: attachment identifiers>> |
| Regression tests executed and results | <<FILL: list with pass or fail>> |
| If failed, new incident number raised | <<FILL: TI number, or N/A>> |
| Original incident status after this re-execution | Closed-resolved / Still open / Superseded by <<FILL>> |
| Closure confirmed by (name, role, date) | <<FILL: QA for C4 to C6>> |
A failed re-execution raises a new incident referencing the original. It does not reopen the same authorization for a further attempt, because reusing the authorization hides how many attempts were made.
9. References
21 CFR 211.192, which requires that unexplained discrepancies be thoroughly investigated with the conclusion and follow-up recorded. The same logic applies to a failed validation test result. 21 CFR Part 11, for the integrity and attributability of electronically captured re-execution evidence. EU GMP Annex 15, Qualification and Validation (2015), which requires deviations from validation protocols to be documented with appropriate justification under quality risk management. EU GMP Annex 11, Computerised Systems (2011, currently in force), for reporting and assessment of deviations arising during validation. The revision published in draft on 7 July 2025, consultation closed 7 October 2025, is not final. ICH Q9(R1), Quality Risk Management, for the risk basis of the approval tiers. FDA guidance “Computer Software Assurance for Production and Quality Management System Software”, issued 3 February 2026, for the risk-based assurance context. FDA 2018 data integrity guidance, MHRA GxP Data Integrity Guidance and Definitions, and PIC/S PI 041, for the ALCOA+ expectations applied to the re-execution record. ISPE GAMP 5 Second Edition (2022), for the lifecycle context. Reference only.
Confirm the current version and clause numbers of each reference before issue.
Filled specimen
The following shows the form completed for a re-execution during the OQ of a laboratory information management system in a biologics QC laboratory. The company, system, names, and numbers are illustrative.
Sections 1 to 3
| Field | Entry |
|---|---|
| Authorization number | RTA-OQ-LIMS-009 |
| Test incident number | TI-OQ-LIMS-014 |
| QMS deviation number | VAL-DEV-2026-031 |
| Incident classification (QA confirmed) | C5, defect, high GxP impact |
| Protocol | OQ-LIMS-008, Operational Qualification of the LIMS, v1.1 |
| Validation phase | OQ |
| System | LIMS, instance LIMS-QUAL |
| Original failed test case and step | TC-017 step 3, specification evaluation of a potency result against the release limit |
| Original failure date and time | 06 July 2026, 09:41 |
| Original failed record reference | OQ-LIMS-008 execution page 24, marked FAIL, annotated “see TI-OQ-LIMS-014” |
| Prior re-execution attempts on this step | 0 |
| Root cause statement | The specification evaluation applied the release limit as an exclusive comparison (result must be strictly greater than 80.0 percent) rather than the inclusive comparison specified in URS-LIMS-044 (result greater than or equal to 80.0 percent). A boundary result of exactly 80.0 percent was evaluated as out of specification. The comparison operator was set to ”>” in the specification rule builder; the configuration specification did not state which operator to use. |
| Investigation method | Configuration export compared against URS-LIMS-044 and the analytical method; five-whys on the build step |
| Evidence confirming the cause | ATT-1 specification rule export showing ”>”; ATT-2 URS-LIMS-044 extract; ATT-3 boundary test screenshots at 79.9, 80.0, 80.1 percent |
| Cause reproduced? | Yes, reproduced on three boundary values on 06 July 2026 |
| Root cause accepted by | J. Mbeki, Validation Lead, 08 July 2026; confirmed by S. Larsen, QA, 08 July 2026 |
| Corrective action description | Comparison operator changed from ”>” to ”>=” on the potency release specification rule, and on the four other release specification rules built in the same session |
| Type of change | Configuration change |
| Change control reference | CR-LIMS-2026-063 |
| CAPA reference | CAPA-2026-039, add an explicit operator column to the specification configuration workbook and a second-person verification step in the build checklist |
| Implemented by | T. Nguyen, LIMS Administrator, 09 July 2026 |
| Completion verified by | R. Adeyemi, LIMS Analyst, 09 July 2026, signed |
| How completion was verified | Configuration export re-pulled and compared line by line against URS-LIMS-044 and the four other affected specification rules |
Section 4, scope
| Field | Entry |
|---|---|
| Scope and impact assessment reference | SIA-014 |
| Primary re-test scope | TC-017 steps 3, 4, and 5, executed at boundary values 79.9, 80.0, and 80.1 percent |
| Acceptance criterion, quoted | ”A potency result equal to or greater than 80.0 percent shall be evaluated as within specification; a result below 80.0 percent shall be evaluated as out of specification and flagged for investigation.” (OQ-LIMS-008 v1.1, TC-017) |
| Acceptance criterion changed? | No |
| Shared logic touched? | Yes, the specification rule engine is shared across all release specifications |
| Shared configuration object touched? | Yes, four other release specification rules built in the same session |
| Interface touched? | No |
| Security role or workflow touched? | No |
| Audit trail or signature behaviour touched? | No |
| Test cases already PASS while the defect was present? | Yes, TC-018 and TC-019 evaluated non-boundary results only and never challenged the boundary |
| Environment or build changed since original execution? | No, build 9.1.4 throughout |
| Regression test cases in scope | TC-018 and TC-019 re-executed with boundary values added; new boundary checks added for the four other affected specification rules (TC-020a to TC-020d) |
| Regression scope justification | The correction changed a comparison operator on five specification rules sharing one rule engine. Any test whose result depended on a specification evaluation could have passed only because it never exercised the boundary, so all specification-evaluation test cases are re-executed with boundary values added. Test cases TC-021 onward cover sample login and worklist routing, which do not call the specification rule engine, and are therefore excluded. |
| Regression waived? | No |
Sections 5 to 8
| Field | Entry |
|---|---|
| Environment | LIMS-QUAL |
| Build | 9.1.4 |
| Environment matches qualified target? | Yes |
| Configuration set | Specification rule set SPEC-REL-2026-02 as amended by CR-LIMS-2026-063 |
| Test data set | TD-LIMS-07, controlled, checked out 10 July 2026 |
| Interfaces active or stubbed | Instrument interface stubbed; ERP interface not exercised by these test cases |
| Environment confirmed by | J. Mbeki, 10 July 2026, version screen capture ATT-4 |
| Attestation statements 1 to 8 | All Yes |
| Attested by | J. Mbeki, Validation Lead, signed 10 July 2026 |
| Approvals | Prepared J. Mbeki 10 July; SME review T. Nguyen 10 July; System owner P. Costa 10 July; QA S. Larsen 10 July; Quality Head D. Rahman 10 July (required, C5) |
| Re-execution record reference | OQ-LIMS-008 addendum 1, pages A1 to A9 |
| Executed by | R. Adeyemi, LIMS Analyst |
| Execution date and time | 13 July 2026, 08:15 to 11:40 |
| Result | Pass. 80.0 percent evaluated as within specification; 79.9 percent evaluated as out of specification and flagged; 80.1 percent within specification |
| Regression results | TC-018 Pass, TC-019 Pass, TC-020a to TC-020d all Pass at boundary |
| New incident raised | N/A |
| Original incident status | Closed-resolved |
| Closure confirmed by | S. Larsen, QA, 15 July 2026 |
Read the specimen in order and the logic is visible: the cause names a specific operator and the specification gap that allowed it, the correction was verified by someone other than the person who made it, the regression scope was set by what the shared rule engine could reach rather than by what the schedule allowed, the boundary values were the exact values that exposed the defect, and every approval date precedes the execution date. That last point is what an audit trail check will confirm or contradict.
Common inspection findings this form prevents
- Re-execution records that exist with no documented authorization, so there is no evidence anyone decided the re-test was legitimate.
- Authorization forms signed after the re-execution ran, contradicted by the system audit trail.
- Re-tests approved with the root cause recorded as “unknown” or “not determined”, meaning the re-test was an attempt to see whether the failure would recur.
- Corrective actions verified by the same person who implemented them.
- Re-execution performed on a different build or environment than the one the failure occurred on, with the difference unrecorded.
- Acceptance criteria quietly relaxed between the original execution and the re-test, so the re-test passes against an easier target.
- Regression skipped after a fix to shared logic, with no justification and no QA sign-off on the omission.
- Test cases that passed while a defective condition was present, left as PASS and never revisited.
- Multiple re-execution attempts on the same step recorded as a single authorization, so the number of attempts is not visible.
- Higher-impact re-tests approved at the same level as trivial ones, with no escalation for GxP-critical functions.
- The person who executed the failing test also approving its re-execution.
How to adapt this form
- Set your form number, numbering scheme, and the incident classification labels in section 1 to match your own procedure. If you use Critical, Major, and Minor rather than C1 to C6, rewrite the approval tier table in section 7 against your own severity terms and keep the escalation at the top severity.
- Decide which classes require a QMS deviation number in field 3 and make that conditional rule explicit, so a form cannot be approved with the field left blank.
- Add any regression prompts specific to your technology to section 4.2. Systems with recipe inheritance, master data hierarchies, multi-tenant configuration, or shared report templates each deserve their own prompt.
- If you run paper execution, add a field for the controlled copy number of the re-execution pages so the new record is traceable to a controlled issue.
- Set your attempt limit in your governing procedure and add a field to section 1 that forces disclosure of the count. The count is the signal, and hiding it is how testing into compliance survives review.
- Keep the attestation in section 6 as a signed statement rather than a tick box. A signature against a named statement is materially different from an unattributed mark.
- If your electronic QMS holds this form, configure the workflow so the approval step cannot be completed after the execution record is created, and so the executor cannot be selected as an approver.
- Confirm every regulation in section 9 against the current published version before issue, in particular the status of the EU GMP Annex 11 revision, which was still in draft at the time of writing.