QC Worksheet for Pregnancy Testing
Pregnancy Test QC Log
Health Department: ___________________________ Site: _________________ Month: ______________
Test Name: _______________________________________________ Manufacturer: _________________
| |Lot Number |Expiration Date |Expected result |Manufacturer |
|Pos Control | | | | |
|Neg Control | | | | |
|Pregnancy Kit | | |- na - | |
|Date |Observed Positive |Observed Negative |Internal Bar Observed |Pass/ Fail |Initials |
| | | |(Y/N) | | |
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Internal Control Expected Result: Control Bar Present
Yes = Control Bar Present No = Control Bar Not Present
Please Note: When bar is not present, a “Failed Test Form” must be completed. All other QC errors require completion of a Continuous Quality Improvement Form
|Date |Corrective Action: (use reverse side as needed) |
| | |
| | |
| | |
___________________________ _____/_____/___ ______________________________ ____/_____/_____
Site Coordinator Date Laboratory Director/Technical Consultant Date
RLF-50
Rev. 6/9/2006
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