Urinalysis QC Log Form
Record urinalysis quality control details for ongoing laboratory accuracy and compliance.
Date and Time of QC Check
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Operator Full Name
*
First Name
Last Name
QC Material Type
*
Please Select
Level 1 (Negative)
Level 2 (Positive)
Level 3 (High Positive)
Other
QC Lot/Batch Number
*
Test Strip or Device ID
*
Test Parameters Checked
*
Glucose
Protein
pH
Leukocytes
Nitrite
Ketones
Blood
Bilirubin
Urobilinogen
Specific Gravity
Other
QC Results
*
Pass
Fail
Corrective Actions Taken (if any)
Supervisor Review Name
First Name
Last Name
Additional Notes or Comments
Submit Log
Should be Empty: