Collection Site Checklist (Page 2 of 2) in pdf

 Secure urination facility before the collection (If

record the date and time of collection; sign

single-toilet room with a full-length privacy door)

statement; enter actual name of delivery service

(Parts 40.41 & 43).

transferring the specimen to laboratory (Part

- Secures any water sources or make them

40.73(a)(2)).

 Ensure that all copies of the CCF are legible and

unavailable to employees (e.g., turn off water

inlet, tape handles to prevent opening faucets).

complete (Part 40.73(a)(3)).

 Remove Copy 5 of the CCF and give it to the

- Ensures that the water in the toilet tank contains

bluing agent.

employee (Part 40.73(a)(4)).

 Place specimen bottles and Copy 1 of CCF in plastic

- Ensures that soap, disinfectants, cleaning

agents, or other possible adulterants are not

bag and secure both pouches of plastic bag (Part

present.

40.73(a)(5)-(a)(6)).

 Advise employee that he/she may leave the site

- Inspects the site to ensure that no foreign or

unauthorized substances are present.

(Part 40.73(a)(7)).

 Recheck the urination facility, performing all steps as

- Tapes or otherwise securely shuts any movable

toilet tank or puts bluing agent in the tank.

was done prior to the collection to ensure the site’s

- Ensures that undetected access (e.g., through a

continued integrity.

door not in your view) is not possible.

- Secures areas and items (e.g., ledges, trash

receptacles, paper-towel holders, under-sink

areas, drop-down ceiling panels) that appear

suitable for concealing contaminants.

 Direct employee to go into room used for urination

and instruct employee to:

- Provide at least 45 ml of urine.

- Not flush the toilet.

- Return specimen to the collector as soon as the

void is complete.

- Set a reasonable time limit for voiding (Part

40.63(d)(2)).

- Allow only the employee into the room used for

urination (40.41(d)(1)).

 Check that the specimen:

- Contains at least 45 ml of urine. If not, follow shy

bladder procedure (Part 40.65(a)).

- Reads temperature strip within 4 minutes (Part

40.65(b)).

 Mark appropriate box in Step 2 of CCF (Yes =

between 90 and 100 degrees).

 Check specimen for signs of tampering (Part 40.65).

 Check specimen for unusual color, foreign

objects/material, or other signs of tampering (odor).

 Mark box in Step 2 of the CCF indicating a split

specimen collection (Part 40.71(b)(1)).

 Pour at least 30 ml of urine into the primary

specimen bottle (Part 40.71(b)(2)).

 Pour at least 15 ml of urine into the secondary

specimen bottle (Part 40.71(b)(2)).

 Secure the lids or caps on the specimen bottles

(Part 40.71(b)(4)).

 Place the tamper-evident seals on the specimen

bottles (Part 40.71(b)(5)).

- Dates the specimen bottle seals (Part

40.71(b)(6)).

- Ensures that the employee initials specimen

bottle seals (Part 40.71(b)(7)).

 Direct employee to read and sign certification

statement on Copy 2, Step 5 of CCF and to provide

date of birth, printed name, day and evening contact

telephone numbers (Part 40.71(a)(1)).

 Print collector name in Copy 1, Step 4 of CCF;

Collection Site Checklist Page 2

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