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AtomicQMS Service
2025-12-27 11:24:08 -05:00
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Forms/Collection-Forms/FRM-BIO-001-Specimen-Collection-Log.md Normal file
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# Specimen Collection Log
| Form ID | FRM-BIO-001 | Revision | 1.0 |
|---------|-------------|----------|-----|
---
## Collection Session Information
| Field | Entry |
|-------|-------|
| Collection Date | |
| Collector Name | |
| Collector ID | |
| Collection Site/Location | |
| Protocol/Study ID | |
| Batch Number | |
---
## Specimen Collection Record
### Specimen 1
| Field | Entry |
|-------|-------|
| Specimen ID (Barcode) | |
| Subject/Donor ID | |
| Consent Verified? | ☐ Yes |
| Verification Method | ☐ Wristband ☐ Verbal ☐ Photo ID ☐ Other: _______ |
| Specimen Type | ☐ Blood ☐ Tissue ☐ Urine ☐ CSF ☐ Other: _______ |
| Collection Container | |
| Collection Time | : (24hr) |
| Volume/Quantity | |
| Collection Site (anatomical) | |
| Ischemia Time (if tissue) | Warm: ___ min Cold: ___ min |
| Specimen Appearance | ☐ Normal ☐ Hemolyzed ☐ Lipemic ☐ Icteric ☐ Other: _______ |
| Notes/Deviations | |
### Specimen 2
| Field | Entry |
|-------|-------|
| Specimen ID (Barcode) | |
| Subject/Donor ID | |
| Consent Verified? | ☐ Yes |
| Verification Method | ☐ Wristband ☐ Verbal ☐ Photo ID ☐ Other: _______ |
| Specimen Type | ☐ Blood ☐ Tissue ☐ Urine ☐ CSF ☐ Other: _______ |
| Collection Container | |
| Collection Time | : (24hr) |
| Volume/Quantity | |
| Collection Site (anatomical) | |
| Ischemia Time (if tissue) | Warm: ___ min Cold: ___ min |
| Specimen Appearance | ☐ Normal ☐ Hemolyzed ☐ Lipemic ☐ Icteric ☐ Other: _______ |
| Notes/Deviations | |
### Specimen 3
| Field | Entry |
|-------|-------|
| Specimen ID (Barcode) | |
| Subject/Donor ID | |
| Consent Verified? | ☐ Yes |
| Verification Method | ☐ Wristband ☐ Verbal ☐ Photo ID ☐ Other: _______ |
| Specimen Type | ☐ Blood ☐ Tissue ☐ Urine ☐ CSF ☐ Other: _______ |
| Collection Container | |
| Collection Time | : (24hr) |
| Volume/Quantity | |
| Collection Site (anatomical) | |
| Ischemia Time (if tissue) | Warm: ___ min Cold: ___ min |
| Specimen Appearance | ☐ Normal ☐ Hemolyzed ☐ Lipemic ☐ Icteric ☐ Other: _______ |
| Notes/Deviations | |
### Specimen 4
| Field | Entry |
|-------|-------|
| Specimen ID (Barcode) | |
| Subject/Donor ID | |
| Consent Verified? | ☐ Yes |
| Verification Method | ☐ Wristband ☐ Verbal ☐ Photo ID ☐ Other: _______ |
| Specimen Type | ☐ Blood ☐ Tissue ☐ Urine ☐ CSF ☐ Other: _______ |
| Collection Container | |
| Collection Time | : (24hr) |
| Volume/Quantity | |
| Collection Site (anatomical) | |
| Ischemia Time (if tissue) | Warm: ___ min Cold: ___ min |
| Specimen Appearance | ☐ Normal ☐ Hemolyzed ☐ Lipemic ☐ Icteric ☐ Other: _______ |
| Notes/Deviations | |
---
## Processing Summary
| Field | Entry |
|-------|-------|
| Total Specimens Collected | |
| Specimens with Deviations | |
| Processing Start Time | : (24hr) |
| Processing End Time | : (24hr) |
| Processed By | |
## Aliquot Summary (if applicable)
| Specimen ID | # Aliquots | Volume Each | Storage Location | Temp |
|-------------|------------|-------------|------------------|------|
| | | | | |
| | | | | |
| | | | | |
| | | | | |
---
## Transfer Information
| Field | Entry |
|-------|-------|
| Transferred To | |
| Transfer Time | : (24hr) |
| Transport Condition | ☐ Ambient ☐ 4°C ☐ Frozen ☐ LN2 |
| Received By | |
| Receipt Time | : (24hr) |
| Condition on Receipt | ☐ Acceptable ☐ Compromised (describe below) |
Notes on condition:
---
## Verification
| Field | Entry |
|-------|-------|
| All specimens labeled correctly? | ☐ Yes |
| All documentation complete? | ☐ Yes |
| Any deviations reported? | ☐ Yes ☐ No ☐ N/A |
| Deviation Report # (if applicable) | |
### Collector Signature
| Field | Entry |
|-------|-------|
| Signature | |
| Date | |
| Time | |
### Supervisor Review (if deviations noted)
| Field | Entry |
|-------|-------|
| Reviewed By | |
| Date | |
| Comments | |
---
*Form FRM-BIO-001 Rev 1.0 - Specimen Collection Log*