Sync template from atomicqms-style deployment

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2025-12-27 11:24:08 -05:00
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# Document Change Request Form
| Form ID | FRM-001 | Revision | 1.0 |
|---------|---------|----------|-----|
---
## Section 1: Request Information
| Field | Entry |
|-------|-------|
| Request Date | |
| Requested By | |
| Department | |
## Section 2: Document Information
| Field | Entry |
|-------|-------|
| Document Number | |
| Document Title | |
| Current Revision | |
## Section 3: Change Description
### Type of Change
- [ ] New Document
- [ ] Revision to Existing Document
- [ ] Document Obsolescence
### Description of Change
*(Describe the proposed change in detail)*
### Reason for Change
*(Explain why this change is needed)*
## Section 4: Impact Assessment
### Affected Areas
- [ ] Training Required
- [ ] Other Documents Affected
- [ ] Process Changes Required
- [ ] Validation Impact
### List Affected Documents
## Section 5: Approvals
| Role | Name | Signature | Date |
|------|------|-----------|------|
| Requester | | | |
| Document Owner | | | |
| Quality Assurance | | | |
---
*Form FRM-001 Rev 1.0*

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# Corrective and Preventive Action (CAPA) Form
| Form ID | FRM-003 | Revision | 1.0 |
|---------|---------|----------|-----|
---
## Section 1: CAPA Identification
| Field | Entry |
|-------|-------|
| CAPA Number | |
| Date Initiated | |
| Initiated By | |
| CAPA Owner | |
| Target Closure Date | |
## Section 2: Classification
### Type
- [ ] Corrective Action
- [ ] Preventive Action
### Source
- [ ] Customer Complaint
- [ ] Internal Audit
- [ ] External Audit
- [ ] Process Deviation
- [ ] Nonconforming Product
- [ ] Management Review
- [ ] Other: ____________
### Priority
- [ ] Critical (5 business days)
- [ ] Major (15 business days)
- [ ] Minor (30 business days)
## Section 3: Problem Description
*(Describe the nonconformity or potential nonconformity)*
## Section 4: Immediate Containment
*(Actions taken to contain the immediate impact)*
## Section 5: Root Cause Investigation
### Investigation Method Used
- [ ] 5 Whys
- [ ] Fishbone Diagram
- [ ] Fault Tree Analysis
- [ ] Other: ____________
### Root Cause Determination
## Section 6: Corrective/Preventive Actions
| Action | Responsible | Due Date | Status |
|--------|-------------|----------|--------|
| | | | |
| | | | |
| | | | |
## Section 7: Effectiveness Verification
| Criteria | Method | Result |
|----------|--------|--------|
| | | |
Verification Date: ____________
Verified By: ____________
## Section 8: Closure
| Role | Name | Signature | Date |
|------|------|-----------|------|
| CAPA Owner | | | |
| Quality Approval | | | |
---
*Form FRM-003 Rev 1.0*

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# Internal Audit Checklist
| Form ID | FRM-006 | Revision | 1.0 |
|---------|---------|----------|-----|
---
## Audit Information
| Field | Entry |
|-------|-------|
| Audit Number | |
| Audit Date | |
| Area/Process Audited | |
| Lead Auditor | |
| Auditee(s) | |
---
## Checklist Items
| # | Requirement/Question | Reference | C/NC/NA | Evidence/Notes |
|---|---------------------|-----------|---------|----------------|
| 1 | Are current versions of applicable procedures available? | SOP-001 | | |
| 2 | Are personnel trained on applicable procedures? | SOP-003 | | |
| 3 | Are training records current and complete? | SOP-003 | | |
| 4 | Are records properly maintained and retrievable? | SOP-001 | | |
| 5 | Are nonconformities being documented and addressed? | SOP-002 | | |
| 6 | Are CAPAs being completed on time? | SOP-002 | | |
| 7 | Is equipment calibrated and maintained? | | | |
| 8 | Are process controls being followed? | | | |
| 9 | Are quality objectives being monitored? | | | |
| 10 | | | | |
**Legend:** C = Conforming, NC = Nonconforming, NA = Not Applicable
---
## Findings Summary
| Finding # | Type | Description | Clause Reference |
|-----------|------|-------------|------------------|
| | | | |
| | | | |
---
## Auditor Signature
| Auditor | Signature | Date |
|---------|-----------|------|
| | | |
---
*Form FRM-006 Rev 1.0*

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# Compatibility Testing Log
| Form ID | FRM-BB-001 | Revision | 1.0 |
|---------|-------------|----------|-----|
---
## Patient Information
| Field | Entry |
|-------|-------|
| Patient Name | |
| MRN | |
| Date of Birth | |
| Sex | ☐ Male ☐ Female |
| Location/Unit | |
| Ordering Physician | |
| Date of Request | |
| Time of Request | |
---
## Specimen Information
| Field | Entry |
|-------|-------|
| Date Collected | |
| Time Collected | |
| Collected By | |
| Phlebotomist ID | |
| Tube Type | ☐ EDTA ☐ Clot ☐ Both |
| Specimen Acceptable? | ☐ Yes ☐ No (reason: _______) |
| Previous Records Available? | ☐ Yes ☐ No ☐ N/A |
---
## ABO/Rh Typing
### Current Sample
| Test | Result | Interpretation |
|------|--------|----------------|
| Anti-A | ☐ Pos ☐ Neg | |
| Anti-B | ☐ Pos ☐ Neg | |
| Anti-D | ☐ Pos ☐ Neg | |
| A1 Cells | ☐ Pos ☐ Neg | |
| B Cells | ☐ Pos ☐ Neg | |
**ABO Type:** ☐ A ☐ B ☐ AB ☐ O
**Rh Type:** ☐ Positive ☐ Negative
**Weak D Testing (if applicable):**
☐ Not performed ☐ Positive ☐ Negative
### Historical Results (if available)
| Date | ABO | Rh | Source |
|------|-----|----|--------|
| | | | |
| | | | |
**Results Consistent?** ☐ Yes ☐ No (see discrepancy resolution)
---
## Antibody Screening
| Field | Entry |
|-------|-------|
| Method | ☐ Tube ☐ Gel ☐ Solid Phase |
| Enhancement | ☐ LISS ☐ PEG ☐ None |
| Screen Cell Lot # | |
| Expiration Date | |
### Screen Cell Results
| Cell | Immediate Spin | 37°C | AHG | CC |
|------|----------------|------|-----|-----|
| I | | | | |
| II | | | | |
| III | | | | |
**Antibody Screen Result:** ☐ Negative ☐ Positive
**If Positive, Antibody Identified:**
---
## Antibody Identification (if screening positive)
| Field | Entry |
|-------|-------|
| Panel Lot # | |
| Method | |
| Antibody(ies) Identified | |
| Clinical Significance | ☐ Yes ☐ No |
| Phenotyped Units Required? | ☐ Yes ☐ No |
| Phenotype Requirements | |
| Panel Cell | Results | Antigen Correlation |
|------------|---------|---------------------|
| 1 | | |
| 2 | | |
| 3 | | |
| 4 | | |
| 5 | | |
| 6 | | |
| 7 | | |
| 8 | | |
| 9 | | |
| 10 | | |
| 11 | | |
---
## Crossmatch
### Unit 1
| Field | Entry |
|-------|-------|
| Unit Number | |
| ABO/Rh | |
| Expiration Date | |
| Antigen Typed? | ☐ Yes: _______ ☐ No ☐ N/A |
| Phase | Result | Interpretation |
|-------|--------|----------------|
| Immediate Spin | ☐ Compatible ☐ Incompatible | |
| 37°C | ☐ Compatible ☐ Incompatible | |
| AHG | ☐ Compatible ☐ Incompatible | |
| Coombs Control | ☐ Valid ☐ Invalid | |
**Final Result:** ☐ Compatible ☐ Incompatible
### Unit 2
| Field | Entry |
|-------|-------|
| Unit Number | |
| ABO/Rh | |
| Expiration Date | |
| Antigen Typed? | ☐ Yes: _______ ☐ No ☐ N/A |
| Phase | Result | Interpretation |
|-------|--------|----------------|
| Immediate Spin | ☐ Compatible ☐ Incompatible | |
| 37°C | ☐ Compatible ☐ Incompatible | |
| AHG | ☐ Compatible ☐ Incompatible | |
| Coombs Control | ☐ Valid ☐ Invalid | |
**Final Result:** ☐ Compatible ☐ Incompatible
### Unit 3
| Field | Entry |
|-------|-------|
| Unit Number | |
| ABO/Rh | |
| Expiration Date | |
| Antigen Typed? | ☐ Yes: _______ ☐ No ☐ N/A |
| Phase | Result | Interpretation |
|-------|--------|----------------|
| Immediate Spin | ☐ Compatible ☐ Incompatible | |
| 37°C | ☐ Compatible ☐ Incompatible | |
| AHG | ☐ Compatible ☐ Incompatible | |
| Coombs Control | ☐ Valid ☐ Invalid | |
**Final Result:** ☐ Compatible ☐ Incompatible
---
## Electronic Crossmatch (if applicable)
| Field | Entry |
|-------|-------|
| Two ABO/Rh on file? | ☐ Yes ☐ No |
| Results consistent? | ☐ Yes ☐ No |
| Antibody screen negative? | ☐ Yes ☐ No |
| Computer system validated? | ☐ Yes |
---
## Special Requirements
| Requirement | Ordered? | Provided? |
|-------------|----------|-----------|
| CMV Negative | ☐ | ☐ |
| Irradiated | ☐ | ☐ |
| Leukoreduced | ☐ | ☐ |
| Washed | ☐ | ☐ |
| Volume Reduced | ☐ | ☐ |
| HbS Negative | ☐ | ☐ |
| Antigen Negative: _______ | ☐ | ☐ |
---
## Results Summary
| Field | Entry |
|-------|-------|
| ABO/Rh | |
| Antibody Screen | ☐ Negative ☐ Positive |
| Antibodies Identified | |
| Units Crossmatched | |
| Units Compatible | |
| Units Available for Issue | |
---
## Verification
### Performed By
| Field | Entry |
|-------|-------|
| Technologist Name | |
| Tech ID | |
| Date | |
| Time | |
| Signature | |
### Reviewed By (if required)
| Field | Entry |
|-------|-------|
| Reviewer Name | |
| Date | |
| Signature | |
---
## Discrepancy Resolution (if applicable)
| Field | Entry |
|-------|-------|
| Type of Discrepancy | |
| Investigation Performed | |
| Resolution | |
| Resolved By | |
| Date | |
| Supervisor Review | |
---
*Form FRM-BB-001 Rev 1.0 - Compatibility Testing Log*

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# Training Record Form
| Form ID | FRM-004 | Revision | 1.0 |
|---------|---------|----------|-----|
---
## Section 1: Employee Information
| Field | Entry |
|-------|-------|
| Employee Name | |
| Employee ID | |
| Department | |
| Job Title | |
## Section 2: Training Information
| Field | Entry |
|-------|-------|
| Training Title | |
| Training Date | |
| Training Duration | |
| Trainer Name | |
| Trainer Qualification | |
### Training Type
- [ ] Initial Training
- [ ] Retraining
- [ ] Refresher
- [ ] Procedure Update
### Delivery Method
- [ ] Classroom
- [ ] On-the-Job
- [ ] Self-Study
- [ ] Computer-Based
- [ ] Other: ____________
## Section 3: Training Content
*(List topics covered or attach training materials)*
## Section 4: Assessment
### Assessment Method
- [ ] Written Test
- [ ] Practical Demonstration
- [ ] Verbal Assessment
- [ ] Observation
### Assessment Results
| Metric | Result |
|--------|--------|
| Score (if applicable) | |
| Pass/Fail | |
## Section 5: Signatures
| Role | Name | Signature | Date |
|------|------|-----------|------|
| Trainee | | | |
| Trainer | | | |
| Supervisor | | | |
---
*Form FRM-004 Rev 1.0*

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