Blood Processing Record Form
Use this form to record blood collection reference details, processing steps, quality checks, storage conditions, and final disposition for each blood unit or component.
Donor / Collection Reference
Record / Reference ID
*
Blood Unit / Bag ID
*
Collection Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Collection Site / Facility
*
Collector / Phlebotomist Name or ID
*
Blood Product Processing Details
Blood Type / ABO and Rh
*
A+
A-
B+
B-
AB+
AB-
O+
O-
Component Type Processed
*
Please Select
Whole Blood
Red Cells
Plasma
Platelets
Cryoprecipitate
Other
Processing Method / Procedure
*
Please Select
Centrifugation
Separation
Filtration
Irradiation
Leukoreduction
Pooling
Aliquoting
Other
Processing Start Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Processing End Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Processing Notes / Remarks
Testing / Quality Control
Temperature on Receipt (°C)
*
Visual Inspection Result
*
Acceptable
Clotted
Hemolyzed
Lipemic
Contaminated
Other
Infectious Disease / Screening Status
*
Pending
Negative
Positive
Repeat Required
Not Applicable
QC Result
*
Pass
Fail
QC Comments / Exception Notes
Storage, Release, and Disposition
Storage Location
*
Please Select
Cold Room
Freezer
Refrigerator
Quarantine Area
Other
Storage Temperature (°C)
*
Expiration / Discard Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Release Status
*
Held
Released
Discarded
Quarantined
Sent for Further Testing
Destination / Receiving Department or Recipient Lab
Final Disposition Reason
Reviewer / Approver Name
*
Submit
Should be Empty: