Document Attestation Form template
A form in the Control of Documents procedure (PR02), mapped to ISO 15189:2022 clause 8.3. Fill it in whenever the task occurs. Used by the quality-management team.
FormISO 15189 · 8.3As needed
Calculated automaticallyRed = outside limits
Your LaboratoryDocument Attestation Form | YL-QM-FRM-02-F02 v1.0
Record: Document Attestation Form — October 2026
I confirm that I have read, understood, and will comply with the document(s) listed below.
I understand that non-compliance may result in disciplinary action.
| No. | Document Title | Document ID | Version | Effective Date | Date Read | Read (✓) | Staff Name | Designation | Signature |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Monthly QC review | REF-26-001 | 2 | 2026-10-01 | 2026-10-01 | R. Naidoo | Medical Technologist | ||
| 2 | Equipment maintenance | REF-26-002 | 2 | 2026-10-08 | 2026-10-08 | S. Dlamini | Senior Technologist | ||
| 3 | Document review | REF-26-003 | 2 | 2026-10-15 | 2026-10-15 | A. Mensah | Quality Officer | ||
| 4 | Competency assessment | REF-26-004 | 2 | 2026-10-22 | 2026-10-22 | L. Banda | Lab Assistant | ||
| 5 | Monthly QC review | REF-26-005 | 2 | 2026-10-29 | 2026-10-29 | K. Otieno | Medical Technologist | ||
| 6 | Equipment maintenance | REF-26-006 | 2 | 2026-11-05 | 2026-11-05 | T. Moyo | Senior Technologist | ||
| 7 | Document review | REF-26-007 | 2 | 2026-11-12 | 2026-11-12 | R. Naidoo | Quality Officer | ||
| 8 | Competency assessment | REF-26-008 | 2 | 2026-11-19 | 2026-11-19 | S. Dlamini | Lab Assistant |
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
- Document Title
- Document ID
- Version
- Effective Date
- Date Read
- Read (✓)
- Staff Name
- Designation
- Signature
Instructions on the form
- I confirm that I have read, understood, and will comply with the document(s) listed below. I understand that non-compliance may result in disciplinary action.
Sign-off
- Completed by
- Reviewed by
Related templates
- Document Distribution and Retrieval Form (PR02-F03)
- Document Change Request Log (PR02-F04)
- Archiving and Removal Form (PR02-F05)
- Guide: ISO 15189 document control
- Guide: ISO 15189 documentation checklist
Clause references are to ISO 15189:2022; check them against your licensed copy of the standard.