QA/QC  › Generic Master Forms  › Lab Test Request
Form · QC-GEN-FRM-003
Lab Test Request Form
40 checkpoints across 6 sections. Before sending any sample to a laboratory for testing. Must be initiated when sample is collected and submitted to lab within 24 hours. Tracks sample handling and test requirements.
40 Checkpoints
6 Sections
Once per sample batch submitted for testing
QA/QC Inspector, QA/QC Manager

Checklist Preview

S.No.CheckpointIS RequirementStatus
S1. Sample Information
S1_01Sample ID/Reference Number
S1_02Sample Collection Date
S1_03Collection Location/Source
S1_04Sample Quantity
S1_05Unit of Quantity
S1_06Physical Description of Sample (color, appearance, condition)
S1_07Sample Collected From (PO/Delivery/On-site)
S1_08Collector Name and Signature
S2. Test Requirements
S2_01Applicable IS Code Number
S2_02IS Code Title/Name
S2_03Edition/Year of IS Code
S2_04Tests Required (as per IS code clause)
S2_05Test Method Reference (IS clause number)
S2_06Number of Test Samples Required
S2_07Any Special Test Requirements (if beyond standard IS code)
S3. Acceptance Criteria and Limits
S3_01Expected Test Parameters
S3_02Tolerance Limits per IS Code
S3_03Acceptance Criteria (detailed description)
S3_04Critical Parameters (mark if any)
S3_05Pass Condition Definition
S3_06Fail Condition Definition
Showing 21 of 40 checkpoints ·
S1. Sample Information
S1_01Sample ID/Reference Number
()
S1_02Sample Collection Date
()
S1_03Collection Location/Source
()
S1_04Sample Quantity
()
S1_05Unit of Quantity
()
S1_06Physical Description of Sample (color, appearance, condition)
()
S1_07Sample Collected From (PO/Delivery/On-site)
()
S1_08Collector Name and Signature
()
S2. Test Requirements
S2_01Applicable IS Code Number
()
S2_02IS Code Title/Name
()
S2_03Edition/Year of IS Code
()
S2_04Tests Required (as per IS code clause)
()
S2_05Test Method Reference (IS clause number)
()
S2_06Number of Test Samples Required
()
S2_07Any Special Test Requirements (if beyond standard IS code)
()
S3. Acceptance Criteria and Limits
S3_01Expected Test Parameters
()
S3_02Tolerance Limits per IS Code
()
S3_03Acceptance Criteria (detailed description)
()
S3_04Critical Parameters (mark if any)
()
S3_05Pass Condition Definition
()
S3_06Fail Condition Definition
()
Showing 21 of 40 ·
Inspection Sign-Off
Submitted to Lab
Lab Acknowledged
Testing In Progress
Testing Completed
Report Received
Prepared By (Name)
Name / Sign / Date
Prepared By (Signature)
Name / Sign / Date
Approved By (QA/QC Manager)
Name / Sign / Date
Manager Signature
Name / Sign / Date
Lab Received By (Name and Signature)
Name / Sign / Date
Lab Acknowledgment Reference/Receipt Number
Name / Sign / Date

Related Templates — Generic Master Forms