Pregnancy Test QC Log Form
Log quality-control checks for pregnancy test kits. Please ensure all fields are completed accurately for each QC entry.
QC Log Entry Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Tester/Operator Name
*
First Name
Last Name
Location/Site
*
Test Kit or Product Name
*
Manufacturer or Brand
*
Lot/Batch Number
*
Expiration Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Sample Type
*
Please Select
Urine
Serum
Control Solution
Other
Test Result Observed
*
Please Select
Positive
Negative
Invalid
Other
QC Notes or Comments
Submit QC Log
Should be Empty: