Project / Work Completion Statement of Compliance Template
General-purpose certification structure. Use any official statutory, regulatory, contract or authority form when one is required.

Project Information
Project / contract: ______________________________
Client / owner: __________________________________
Contractor / responsible organization: __________
Site / location: _________________________________
Completion period / date: _______________________

Compliance Basis
Approved scope / drawing / plan reference: _______
Applicable specification / standard: ____________
Permit / consent / authorization if applicable: _
Inspection / test references: ___________________

Statement
The undersigned confirms, subject to the exceptions listed below, that the work described above has been completed in accordance with the identified approved scope, specifications, standards and documented requirements that apply to this statement.

Exceptions / Outstanding Items
Item: ____________________________________________
Reason / status: __________________________________
Corrective action / target date: _________________
Supporting reference: ____________________________

Supporting Documents
[ ] Inspection / test reports
[ ] Certificates / approvals
[ ] As-built / completion documents
[ ] Other: ________________________________________

Certification
Name: ____________________________________________
Title / authority: _______________________________
Organization: ____________________________________
Signature: _______________________ Date: __________

Important: This generic template does not replace a prescribed government, building, safety, quality or regulatory compliance form.