Code of Ethics, Impartiality & Confidentiality Declaration template

A form in the Personnel, Training and Competence procedure (PR12), mapped to ISO 15189:2022 clauses 4.1, 4.2. Fill it in whenever the task occurs. Used by the quality-management team.

FormISO 15189 · 4.1, 4.2As needed

Calculated automaticallyRed = outside limits

Your LaboratoryCode of Ethics, Impartiality & Confidentiality Declaration | YL-QM-FRM-12-F03 v1.0

Record: Code of Ethics, Impartiality & Confidentiality Declaration — October 2026

Employee NameR. Naidoo

Employee No.REF-26-001

I, the undersigned, have read, understood, and agree to abide by the following principles:

Employee NameR. Naidoo

Signature

Date2026-10-01

Witnessed byT. Moyo

Sign-off

Role	Name	Signature	Date
Completed by
Reviewed by

Shaded cells are calculated automatically. Values in red are outside their limits. † marks a corrected value (see Corrections).

Controlled document. Printed copies are uncontrolled unless stamped.Page 1

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What it records

Employee Name
Employee No.
Employee Name
Signature
Date
Witnessed by

Instructions on the form

I, the undersigned, have read, understood, and agree to abide by the following principles:

Sign-off

Completed by
Reviewed by

Related templates

Use it as a live form in LabToolkit Pro Get it in the ISO 15189 template pack (US$149)

Clause references are to ISO 15189:2022; check them against your licensed copy of the standard.