Checklist For Corrective Action Form
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2Checklist for Corrective Action
_____________
Year/Testing Event_____________ Analyte
Sample number_________
Date Sample Tested________________ Person Performing Test_________________________
Specimen Handling
Were specimens received in an acceptable condition?
Yes □ No □
Were specimens stored according to the instructions on the result forms? Yes □ No □
Were the samples hemolyzed?
Yes □ No □
Were samples tested within the time allowed for sample stability?
Yes □ No □
If applicable, were the samples reconstituted correctly?
Yes □ No □
Notes:________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Clerical Errors
Were the results transcribed onto the forms correctly?
Yes □ No □
Were the results recorded on the correct result form?
Yes □ No □
Was the correct instrument/reagent/kit selected?
Yes □ No □
Were the results recorded in the correct units?
Yes □ No □
Were the results on your evaluation the same as the results you reported? Yes □ No □
Notes:________________________________________________________________________
_____________________________________________________________________________
Quality Control
Were controls in range on the date the proficiency samples were tested?
Yes □ No □
Is there any indication of trending or shifting of the control results?
Yes □ No □
Notes:________________________________________________________________________
_____________________________________________________________________________
Calibration
Were there any problems with the most recent calibration?
Yes □ No □
When was the last calibration performed?
_______________________
How often is a calibration performed?
_______________________
When was the last calibration verification performed?
_______________________
Notes:________________________________________________________________________
_____________________________________________________________________________
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