Sample custody form
Fill in by hand. Put it in the parcel. Keep a copy.
A Sender
Quote reference Q-
Name on report
Contact email
B Samples
| Sample no. | Product name as labelled | Label claim, or “withheld” | Lot | Vials | Container |
|---|---|---|---|---|---|
C Packing
Seals intact yes no
Packed by
Date
Carrier
Tracking number
Signature
D For lab use
Received by
Date and time
Parcel condition
Photo taken yes no
| Sample no. | Lab ID | Vial condition on arrival |
|---|---|---|