Sync template from atomicqms-style deployment
This commit is contained in:
192
Forms/Chain-of-Custody/FRM-BIO-002-Chain-of-Custody.md
Normal file
192
Forms/Chain-of-Custody/FRM-BIO-002-Chain-of-Custody.md
Normal file
@@ -0,0 +1,192 @@
|
||||
# Chain of Custody Form
|
||||
|
||||
| Form ID | FRM-BIO-002 | Revision | 1.0 |
|
||||
|---------|-------------|----------|-----|
|
||||
|
||||
---
|
||||
|
||||
## Specimen Information
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Specimen ID(s) | |
|
||||
| Number of Containers | |
|
||||
| Specimen Type | ☐ Blood ☐ Serum ☐ Plasma ☐ Tissue ☐ DNA ☐ RNA ☐ Cells ☐ FFPE ☐ Other: _______ |
|
||||
| Protocol/Study ID | |
|
||||
| Subject/Donor ID | |
|
||||
| Collection Date | |
|
||||
| Collection Time | |
|
||||
| Collected By | |
|
||||
|
||||
---
|
||||
|
||||
## Required Storage Conditions
|
||||
|
||||
| Condition | Check |
|
||||
|-----------|-------|
|
||||
| ☐ Ambient (15-25°C) | |
|
||||
| ☐ Refrigerated (2-8°C) | |
|
||||
| ☐ Frozen (-20°C) | |
|
||||
| ☐ Ultra-low (-80°C) | |
|
||||
| ☐ Liquid Nitrogen (-196°C) | |
|
||||
| ☐ Other: _______ | |
|
||||
|
||||
**Special Handling Instructions:**
|
||||
|
||||
---
|
||||
|
||||
## Chain of Custody Log
|
||||
|
||||
### Transfer 1
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Released By | |
|
||||
| Title/Role | |
|
||||
| Date | |
|
||||
| Time | |
|
||||
| Signature | |
|
||||
| Location Transferred From | |
|
||||
| Storage Condition at Release | |
|
||||
| Received By | |
|
||||
| Title/Role | |
|
||||
| Date | |
|
||||
| Time | |
|
||||
| Signature | |
|
||||
| Location Transferred To | |
|
||||
| Condition on Receipt | ☐ Acceptable ☐ Compromised |
|
||||
| Notes | |
|
||||
|
||||
### Transfer 2
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Released By | |
|
||||
| Title/Role | |
|
||||
| Date | |
|
||||
| Time | |
|
||||
| Signature | |
|
||||
| Location Transferred From | |
|
||||
| Storage Condition at Release | |
|
||||
| Received By | |
|
||||
| Title/Role | |
|
||||
| Date | |
|
||||
| Time | |
|
||||
| Signature | |
|
||||
| Location Transferred To | |
|
||||
| Condition on Receipt | ☐ Acceptable ☐ Compromised |
|
||||
| Notes | |
|
||||
|
||||
### Transfer 3
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Released By | |
|
||||
| Title/Role | |
|
||||
| Date | |
|
||||
| Time | |
|
||||
| Signature | |
|
||||
| Location Transferred From | |
|
||||
| Storage Condition at Release | |
|
||||
| Received By | |
|
||||
| Title/Role | |
|
||||
| Date | |
|
||||
| Time | |
|
||||
| Signature | |
|
||||
| Location Transferred To | |
|
||||
| Condition on Receipt | ☐ Acceptable ☐ Compromised |
|
||||
| Notes | |
|
||||
|
||||
### Transfer 4
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Released By | |
|
||||
| Title/Role | |
|
||||
| Date | |
|
||||
| Time | |
|
||||
| Signature | |
|
||||
| Location Transferred From | |
|
||||
| Storage Condition at Release | |
|
||||
| Received By | |
|
||||
| Title/Role | |
|
||||
| Date | |
|
||||
| Time | |
|
||||
| Signature | |
|
||||
| Location Transferred To | |
|
||||
| Condition on Receipt | ☐ Acceptable ☐ Compromised |
|
||||
| Notes | |
|
||||
|
||||
---
|
||||
|
||||
## Temperature Monitoring (for transport)
|
||||
|
||||
| Time Point | Temperature | Within Range? | Initials |
|
||||
|------------|-------------|---------------|----------|
|
||||
| Departure | °C | ☐ Yes ☐ No | |
|
||||
| Checkpoint 1 | °C | ☐ Yes ☐ No | |
|
||||
| Checkpoint 2 | °C | ☐ Yes ☐ No | |
|
||||
| Arrival | °C | ☐ Yes ☐ No | |
|
||||
|
||||
**Temperature Monitor ID/Lot:**
|
||||
|
||||
---
|
||||
|
||||
## Shipping Information (if applicable)
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Carrier | |
|
||||
| Tracking Number | |
|
||||
| Ship Date | |
|
||||
| Expected Arrival | |
|
||||
| Actual Arrival | |
|
||||
| Package Condition | ☐ Intact ☐ Damaged (describe below) |
|
||||
| Temperature Indicator Status | ☐ Within range ☐ Exceeded (describe below) |
|
||||
|
||||
Condition/Temperature Notes:
|
||||
|
||||
---
|
||||
|
||||
## Deviation Documentation
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Was specimen condition compromised? | ☐ Yes ☐ No |
|
||||
| If yes, describe deviation: | |
|
||||
| Temperature excursion? | ☐ Yes ☐ No |
|
||||
| If yes, duration: | |
|
||||
| If yes, max/min temp: | |
|
||||
| Action taken: | |
|
||||
| Deviation Report #: | |
|
||||
| Specimen disposition: | ☐ Accepted ☐ Quarantined ☐ Rejected |
|
||||
|
||||
---
|
||||
|
||||
## Final Disposition
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Final Storage Location | |
|
||||
| Freezer/Tank ID | |
|
||||
| Rack/Box Position | |
|
||||
| Date/Time Stored | |
|
||||
| Stored By | |
|
||||
| LIMS Entry Completed? | ☐ Yes |
|
||||
| LIMS Accession # | |
|
||||
|
||||
---
|
||||
|
||||
## Verification
|
||||
|
||||
| Field | Entry |
|
||||
|-------|-------|
|
||||
| Chain of custody complete? | ☐ Yes |
|
||||
| All transfers documented? | ☐ Yes |
|
||||
| Temperature maintained? | ☐ Yes ☐ No (deviation documented) |
|
||||
| Final reviewer signature | |
|
||||
| Date | |
|
||||
|
||||
---
|
||||
|
||||
*Form FRM-BIO-002 Rev 1.0 - Chain of Custody Form*
|
||||
Reference in New Lab Ticket
Block a user