Consultant Evaluation Checklist template
A checklist in the Referral Laboratories and Consultants procedure (PR04), mapped to ISO 15189:2022 clause 6.8. Fill it in whenever the task occurs. Used by the quality-management team.
ChecklistISO 15189 · 6.8As needed
Calculated automaticallyRed = outside limits
Your LaboratoryConsultant Evaluation Checklist | YL-QM-FRM-04-F02 v1.0
Record: Consultant Evaluation Checklist — October 2026
Consultant nameT. Moyo
Specialty
Organisation
Registration no.REF-26-001
Evaluation type
Date2026-10-01
| No. | Requirement | Response | Evidence / comment |
|---|---|---|---|
| 1 | Current registration with the professional council (copy attached) | Yes | Within limits |
| 2 | Qualifications relevant to the advice to be given | Yes | |
| 3 | Experience in the specialty (CV attached) | Yes | |
| 4 | Professional references or previous performance reviewed | No | Within limits |
| 5 | Availability and response time meet the laboratory's needs | Yes | |
| 6 | Communication channel agreed (telephone, email, LIS) | Yes | |
| 7 | Confidentiality agreement signed | Yes | Within limits |
| 8 | Conflict-of-interest declaration signed | Yes | |
| 9 | Professional indemnity in place (where required) | Yes | |
| 10 | Complaints or nonconformities in the previous period reviewed | Yes | Within limits |
| 11 | Memorandum of understanding (PR04-F03) in place or proposed | Yes |
Decision (approve / approve with conditions / reject)
Conditions / commentsWithin limits
Sign-off
| Role | Name | Signature | Date |
|---|---|---|---|
| Evaluated by (Laboratory Manager) | |||
| Approved by (Laboratory Director) |
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
- Requirement
- Response
- Evidence / comment
Sign-off
- Evaluated by (Laboratory Manager)
- Approved by (Laboratory Director)
Related templates
- Referral Laboratory Evaluation Checklist (PR04-F01)
- List of Approved Referral Laboratories and Consultants (PR04-F04)
- Sample Referral Log (PR04-F05)
- Guide: ISO 15189 documentation checklist
Clause references are to ISO 15189:2022; check them against your licensed copy of the standard.