# Specimen Collection Log

| Form ID | FRM-BIO-001 | Revision | 1.0 |
|---------|-------------|----------|-----|

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## Collection Session Information

| Field | Entry |
|-------|-------|
| Collection Date | |
| Collector Name | |
| Collector ID | |
| Collection Site/Location | |
| Protocol/Study ID | |
| Batch Number | |

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## 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 |
|-------------|------------|-------------|------------------|------|
| | | | | |
| | | | | |
| | | | | |
| | | | | |

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## 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:

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## 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 | |

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*Form FRM-BIO-001 Rev 1.0 - Specimen Collection Log*