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DEPARTMENT OF THE ARMY

By Irene Brown,2014-05-19 23:57
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QUALITY CONTROL CHECKLIST. DATE SHIPPED: Shipped via: USPS UPS DHL. FedEx Other: DD Form 2624: COMPLETED. 1. Are blocks 1-10 filled out correctly?

    QUALITY CONTROL CHECKLIST

    DATE SHIPPED: Shipped via: USPS UPS DHL

     FedEx Other:

    DD Form 2624: COMPLETED

    1. Are blocks 1-10 filled out correctly? This includes 2. Block 1 - Your supporting ASAP mailing address or where

    your lab results are sent.

    3. Block 2 Your unit mailing address and UPL telephone

    number. If deployed include CO/1SG email or phone

    number, preferably e-mail address.

    4. Block 3 - Base Area Code, BAC, (example FC05) 5. Block 4 - Unit Identification Code, UIC

    6. Block 5 - Batch number

    7. Block 6 - Date Specimen Colleted

    8. Block 7 Pre-printed specimen number

    9. Block 8 SSN handwritten or pre-printed with DTP 10. Block 9 - Test Basis (IR, IU, IO, PO, etc.)

    11. Block 10 - Test Information (A or B)?

    12. Are there any errors, over-writes, or unreadable SSNs? 13. Are all errors properly corrected (with UPL initial and date)

     and/or documented on a Certificate of Correction? 14. Does the DD 2624 have a Unit Urinalysis Ledger that

     mirrors it?

    15. Does the date on the front of the DD 2624, the back of

     the DD 2624, Unit Urinalysis Ledger, and specimen label

     match?

    16. Are the documents filled out with black ink?

    17. Is the chain of custody (DD 2624, Block 12) correctly

     completed indicating all changes in custody? For DTP Completed DD 2624: 1. Is the UIC and BAC pre-printed on the form? If not, a

     Certificate of Correction must be completed for each batch

    for

     the Specimen labels. Do Not handwrite the UIC and BAC

    on

     the specimen labels. You may handwrite the UIC and BAC

     on the DD Form 2624, but you must blacken out the top

     barcode and initial and date each entry.

    2. Are the bar codes of all voided specimens and/or

     specimens with corrections on the SSN blacked out,

     initialed, and dated?

    3. Is the DD Form 2624 printed Head to Head or are any

     blacken out barcodes only blackened out up to one inch

    from

     the DD Form 2624’s left edge?

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    QUALITY CONTROL CHECKLIST

     UNIT URINALYSIS LEDGER:

    1. Does the Unit Ledger record the soldier’s correct printed

     name and signature?

    2. Does the Unit Ledger record the observer’s correct printed

     name and signature?

    3. Is the Unit Ledger stored in a secure location?

    SPECIMEN LABEL AND BOTTLE: 1. Is the amount of urine adequate for testing (at least 30ml)? 2. Are all entries on the label in the proper location?

    3. Are all bottle caps securely tightened?

    4. Was tamper evident tape placed over the cap of the bottle,

     touching the label on both sides? Is all information

     legible?

    5. If tamper tape broke while the UPL was applying it, was a

     second piece correctly applied and a memorandum

     completed? Remember do not send anything that

     records the donor’s name to the lab.

    6. Are the soldier’s and UPL’s initials recorded on the

     specimen label?

    7. Are all errors properly corrected with initial and date and/or

     with a Certificate of correction?

    8. Are the bar codes on DTP made labels blacked out if the

    SSN

     was corrected?

     SHIPPING:

    1. Did the UPL ensure that the specimen numbers were

     annotated on the box and specimens placed inside the box

    in

     the order they are listed on the corresponding DD 2624? 2. Did the UPL ensure that an absorbent pouch was placed in

     each box?

    3. Did the UPL ensure that all seams on the box were secured

     with one continuous piece of tape (one piece around the

     middle and one on each end)?

    4. Did the UPL ensure that his/her signature (legible) was

     written on the top and bottom of each box, from corner to

     corner, touching the tape on each side?

    5. Did the UPL ensure that the original DD 2624 (front and back

     on one piece of paper printed Head to Head (two separate

     pieces of paper is a NO GO) and any Certificates of

     Correction were placed in an envelope and taped to the top

    of

     the corresponding box?

    6. Did the UPL ensure that each box was placed in a white leak-

     proof bag?

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QUALITY CONTROL CHECKLIST

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