Standardized Test Chain of Custody Form
Use this form to document the transfer, receipt, storage, and return of standardized test materials throughout the custody chain.
Date and Time of Custody Event
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Test Material Description or ID
*
Custody Event Type
*
Received
Transferred
Stored
Returned
Name of Person Transferring Materials
*
Role of Person Transferring Materials
*
Please Select
Test Coordinator
Proctor
Administrator
Courier
Other
Name of Person Receiving Materials
*
Role of Person Receiving Materials
*
Please Select
Test Coordinator
Proctor
Administrator
Courier
Other
Location of Custody Event
*
Condition of Materials at Transfer
*
Sealed and Intact
Opened but Complete
Damaged
Missing Items
Signature of Receiving Person (for custody acknowledgment)
*
Submit
Submit
Should be Empty: