Decedent Chain of Custody Form
Document a single handoff and receipt.
Decedent name
*
First Name
Last Name
Case/reference number
*
Originating location
*
Receiving location
*
Transfer date and time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Releasing staff member name and role
*
Receiving staff member name and role
*
Container or seal identifier
*
Container condition at handoff
*
Please Select
Intact and secure
Minor damage noted
Seal discrepancy noted
Other condition noted
Receiving staff signature
*
Submit Form
Submit Form
Should be Empty: