Critical Result Notification Log template
A log in the Result Release and Critical Results procedure (PR14), mapped to ISO 15189:2022 clause 7.4.1. Fill it in monthly. Used by the laboratory team.
LogISO 15189 · 7.4.1Monthly
Calculated automaticallyRed = outside limits
Your LaboratoryCritical Result Notification Log | YL-LAB-LOG-14-F04 v1.0
Record: Critical Result Notification Log — October 2026
| No. | Date | Time Result Ready | Patient Name / ID | Test / Result | Critical Value | Section | Notified to (Name / Ward) | Method (Phone/In-Person) Phone/In-Person | Time Notified | Read-Back Confirmed? (Y/N) | Notifying Staff Initials |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2026-10-01 | 08:00 | S. Dlamini | 5.10 | 4.93 | Haematology | R. Naidoo | +27 11 555 0110 | 08:00 | Y | TM |
| 2 | 2026-10-08 | 14:00 | A. Mensah | 4.89 | 5.03 | Chemistry | S. Dlamini | +27 11 555 0111 | 14:00 | Y | RN |
| 3 | 2026-10-15 | 08:05 | L. Banda | 5.09 | 5.10 | Microbiology | A. Mensah | +27 11 555 0112 | 08:05 | Y | SD |
| 4 | 2026-10-22 | 13:55 | K. Otieno | 4.96 | 4.91 | Reception | L. Banda | +27 11 555 0113 | 13:55 | N | AM |
| 5 | 2026-10-29 | 08:00 | T. Moyo | 4.89 | 4.91 | Haematology | K. Otieno | +27 11 555 0114 | 08:00 | Y | LB |
| 6 | 2026-11-05 | 14:00 | R. Naidoo | 4.89 | 4.90 | Chemistry | T. Moyo | +27 11 555 0115 | 14:00 | Y | KO |
| 7 | 2026-11-12 | 08:05 | S. Dlamini | 5 | 4.89 | Microbiology | R. Naidoo | +27 11 555 0116 | 08:05 | Y | TM |
| 8 | 2026-11-19 | 13:55 | A. Mensah | 4.99 | 5.11 | Reception | S. Dlamini | +27 11 555 0117 | 13:55 | Y | RN |
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
A4 landscape · first page · showing 8 of 8 rowsExactly as LabToolkit Pro prints it — with your logo and colours
What it records
- Date
- Time Result Ready
- Patient Name / ID
- Test / Result
- Critical Value
- Section
- Notified to (Name / Ward)
- Method (Phone/In-Person)
- Time Notified
- Read-Back Confirmed? (Y/N)
- Notifying Staff Initials
Sign-off
- Completed by
- Reviewed by
Related templates
- List of Persons Authorized to Release Test Reports (PR14-F01)
- List of Persons Authorized to Receive Test Reports (PR14-F02)
- List of Critical Results (alert Values) (PR14-F03)
- Guide: ISO 15189 documentation checklist
Clause references are to ISO 15189:2022; check them against your licensed copy of the standard.