Biospecimen Chain of Custody Form
Track biospecimen handoff, transfer, and receipt details in a clear chain-of-custody workflow.
Specimen Details
Biospecimen / Sample ID
*
Specimen Type
Please Select
Blood
Saliva
Urine
Tissue
Swab
Other
Quantity or Volume Transferred
*
Custody Transfer Information
Released by / From name
*
Released by / From role or department
*
Received by / To name
*
Received by / To role or department
*
Date and time of transfer
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Transfer location or site
*
Condition upon receipt
*
Please Select
Intact
Partially compromised
Temperature concern
Seal broken
Other
Verification and Notes
Seal or Container Status at Handoff
*
Please Select
Intact and secure
Minor issue noted
Damaged or compromised
Not applicable
Comments or Discrepancy Notes
Handoff Confirmation Signature
Submit
Submit
Should be Empty: