Levey-Jennings chart & Westgard multirule monitor template
A qc sheet in the Internal Quality Control procedure (PR23), mapped to ISO 15189:2022 clause 7.3.7.2. Fill it in whenever the task occurs. Used by the laboratory team.
Qc sheetISO 15189 · 7.3.7.2As needed
Calculated automaticallyRed = outside limits
Your LaboratoryLevey-Jennings chart & Westgard multirule monitor | YL-LAB-FRM-23-T01 v1.0
Record: Levey-Jennings chart & Westgard multirule monitor — October 2026
AnalyteGlucose
Unitsmmol/L
Month / yearOctober 2026
Target mean and SD: from at least 20 in-house runs (see the cumulative statistics below), not the insert range.
Level 1QC level 1 · lot 2409-A
Level 2QC level 2 · lot 2409-A
Inputs used in calculations
Level 1 · Target mean5.01
Level 1 · Target SD0.16
Level 2 · Target mean15
Level 2 · Target SD0.42
| Run | Date | L1 result | L1 z | L2 result | L2 z | Rule(s) violated | Status | Corrective action / comment | Initials |
|---|---|---|---|---|---|---|---|---|---|
| 1 | 2026-10-01 | 4.95 | -0.37500 | 14.89 | -0.26190 | ACCEPT | None required | TM | |
| 2 | 2026-10-08 | 4.99 | -0.12500 | 14.69 | -0.73810 | ACCEPT | None required | RN | |
| 3 | 2026-10-15 | 5.04 | 0.18750 | 15.33 | 0.78571 | ACCEPT | None required | SD | |
| 4 | 2026-10-22 | 5.02 | 0.06250 | 15.22 | 0.52381 | ACCEPT | Investigated and repeated: within limits | AM | |
| 5 | 2026-10-29 | 5.01 | 0.00000 | 15.14 | 0.33333 | ACCEPT | None required | LB | |
| 6 | 2026-11-05 | 5.06 | 0.31250 | 15 | 0.00000 | ACCEPT | None required | KO | |
| 7 | 2026-11-12 | 5 | -0.06250 | 14.67 | -0.78571 | ACCEPT | None required | TM | |
| 8 | 2026-11-19 | 5.07 | 0.37500 | 15.21 | 0.50000 | ACCEPT | None required | RN |
Cumulative Statistics (Use ≥20 Results To Set New Targets)
Runs with warning
Level 18
Level 28
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
- Run
- Date
- L1 result
- L1 z
- L2 result
- L2 z
- Rule(s) violated
- Status
- Corrective action / comment
- Initials
Instructions on the form
- Target mean and SD: from at least 20 in-house runs (see the cumulative statistics below), not the insert range.
Sign-off
- Completed by
- Reviewed by
Related templates
- IQC Frequency Determination Form (PR23-F01)
- In-house IQC Preparation Log (PR23-F02)
- IQC Statistical Tool — Levey-jennings Chart Setup (PR23-F03)
- IQC Daily Log (PR23-F04)
- CV Calculator — Alternative IQC Method (PR23-F05)
- Sigma metric & QC strategy planner (PR23-T02)
- Guide: Levey-Jennings charts and Westgard rules
- Guide: ISO 15189 documentation checklist
Clause references are to ISO 15189:2022; check them against your licensed copy of the standard.