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Form · QC-TLB-FRM-001
Sample Dispatch Form (Chain of Custody)
18 checkpoints across 6 sections. Every time samples are dispatched from site to external lab or inter-lab transfer
18 Checkpoints
6 Sections
Per dispatch event
Site QC Engineer, Lab Technician

Checklist Preview

S.No.CheckpointIS RequirementStatus
A. SAMPLE IDENTIFICATION
A1Each sample labelled with unique sample ID (project-date-serial) and cross-referenced on form
Acceptance: Sample ID label durable and tamper-evident; ID matches form row
Cl. 7.4.2 — Identification
OK
NC
NA
HOLD
A2For concrete cubes — record casting date, source (activity/pour), grade, mix ID
Acceptance: Cube marked with waterproof paint: sample ID + cast date + pour reference; cross-referenced in form
Cl. 5 — Cube identification
OK
NC
NA
HOLD
A3For cement / aggregate — record batch, source, quantity sampled, receipt date
Acceptance: Batch, source and receipt date captured; linked to GRN / MTC
Cl. 7.4.2 — Material
OK
NC
NA
HOLD
B. SAMPLE PREPARATION AND INTEGRITY
B1Sample drawn per relevant IS / ISO sampling method (IS 4031, IS 516, IS 2430, etc.)
Acceptance: Sampling method documented; minimum sample quantity collected (e.g., IS 4031 cement ≥ 5 kg)
Cl. 7.3 — Sampling
OK
NC
NA
HOLD
B2Sample sealed in clean, inert container; tamper-evident seal applied
Acceptance: Seal intact; signed across cap/lid; sample unaltered from site condition
Cl. 7.4.4 — Storage
OK
NC
NA
HOLD
B3Concrete cubes: de-moulded after 24±4 hr, cured in water tank at 27±2°C until dispatch
Acceptance: De-moulding and curing regime logged; tank temperature records attached
Cl. 4 — Curing
OK
NC
NA
HOLD
B4Samples photographed before dispatch showing labels and seals
Acceptance: Photos filed with dispatch form; show clear sample ID
Cl. 7.5 — Records
OK
NC
NA
HOLD
C. SAMPLE DETAIL TABLE
C1Row 1: Sample ID, description, quantity, casting date, age at test (if concrete)
Acceptance: Each row fully filled; no blanks; casting date + test age = date of test
Cl. 7.4 — Sample info
OK
NC
NA
HOLD
C2Row continued: Test required (e.g., 28-day compressive strength, fineness, soundness)
Acceptance: Test list complete and per applicable IS; reporting requirements stated
Cl. 7.1 — Test request
OK
NC
NA
HOLD
C3Row continued: Priority (Routine / Urgent); expected report date
Acceptance: Priority and TAT specified; communicated to lab at dispatch
Cl. 7.8 — Reporting
OK
NC
NA
HOLD
Showing 10 of 18 checkpoints ·
A. SAMPLE IDENTIFICATION
A1Each sample labelled with unique sample ID (project-date-serial) and cross-referenced on form
Cl. 7.4.2 — Identification (ISO/IEC 17025)
Sample ID label durable and tamper-evident; ID matches form row
OKNCNAHOLD
A2For concrete cubes — record casting date, source (activity/pour), grade, mix ID
Cl. 5 — Cube identification (IS 516)
Cube marked with waterproof paint: sample ID + cast date + pour reference; cross-referenced in form
OKNCNAHOLD
A3For cement / aggregate — record batch, source, quantity sampled, receipt date
Cl. 7.4.2 — Material (ISO/IEC 17025)
Batch, source and receipt date captured; linked to GRN / MTC
OKNCNAHOLD
B. SAMPLE PREPARATION AND INTEGRITY
B1Sample drawn per relevant IS / ISO sampling method (IS 4031, IS 516, IS 2430, etc.)
Cl. 7.3 — Sampling (ISO/IEC 17025)
Sampling method documented; minimum sample quantity collected (e.g., IS 4031 cement ≥ 5 kg)
OKNCNAHOLD
B2Sample sealed in clean, inert container; tamper-evident seal applied
Cl. 7.4.4 — Storage (ISO/IEC 17025)
Seal intact; signed across cap/lid; sample unaltered from site condition
OKNCNAHOLD
B3Concrete cubes: de-moulded after 24±4 hr, cured in water tank at 27±2°C until dispatch
Cl. 4 — Curing (IS 516)
De-moulding and curing regime logged; tank temperature records attached
OKNCNAHOLD
B4Samples photographed before dispatch showing labels and seals
Cl. 7.5 — Records (ISO/IEC 17025)
Photos filed with dispatch form; show clear sample ID
OKNCNAHOLD
C. SAMPLE DETAIL TABLE
C1Row 1: Sample ID, description, quantity, casting date, age at test (if concrete)
Cl. 7.4 — Sample info (ISO/IEC 17025)
Each row fully filled; no blanks; casting date + test age = date of test
OKNCNAHOLD
C2Row continued: Test required (e.g., 28-day compressive strength, fineness, soundness)
Cl. 7.1 — Test request (ISO/IEC 17025)
Test list complete and per applicable IS; reporting requirements stated
OKNCNAHOLD
C3Row continued: Priority (Routine / Urgent); expected report date
Cl. 7.8 — Reporting (ISO/IEC 17025)
Priority and TAT specified; communicated to lab at dispatch
OKNCNAHOLD
Showing 10 of 18 ·
Inspection Sign-Off
APPROVED
APPROVED WITH CONDITIONS
REJECTED — NCR RAISED
Remarks
Name / Sign / Date
Prepared By
Name / Sign / Date
Reviewed / Approved By
Name / Sign / Date