List of Persons Authorized to Release Test Reports template
A form in the Result Release and Critical Results procedure (PR14), mapped to ISO 15189:2022 clause 7.4.1. Fill it in whenever the task occurs. Used by the laboratory team.
FormISO 15189 · 7.4.1As needed
Calculated automaticallyRed = outside limits
Your LaboratoryList of Persons Authorized to Release Test Reports | YL-LAB-FRM-14-F01 v1.0
Record: List of Persons Authorized to Release Test Reports — October 2026
This list must be reviewed and updated at least annually and upon any changes in authorized personnel.
| No. | Full Name | Designation | Employee No. | Authorization Level (Routine / Urgent / All) | Sections Covered | Date Authorized | Date Authorization Expires | Specimen Signature | Comments |
|---|---|---|---|---|---|---|---|---|---|
| 1 | T. Moyo | Medical Technologist | REF-26-001 | Haematology | 2026-10-01 | 2026-10-01 | Within limits | ||
| 2 | R. Naidoo | Senior Technologist | REF-26-002 | Chemistry | 2026-10-08 | 2026-10-08 | |||
| 3 | S. Dlamini | Quality Officer | REF-26-003 | Microbiology | 2026-10-15 | 2026-10-15 | |||
| 4 | A. Mensah | Lab Assistant | REF-26-004 | Reception | 2026-10-22 | 2026-10-22 | Within limits | ||
| 5 | L. Banda | Medical Technologist | REF-26-005 | Haematology | 2026-10-29 | 2026-10-29 | |||
| 6 | K. Otieno | Senior Technologist | REF-26-006 | Chemistry | 2026-11-05 | 2026-11-05 | |||
| 7 | T. Moyo | Quality Officer | REF-26-007 | Microbiology | 2026-11-12 | 2026-11-12 | Within limits | ||
| 8 | R. Naidoo | Lab Assistant | REF-26-008 | Reception | 2026-11-19 | 2026-11-19 |
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
- Full Name
- Designation
- Employee No.
- Authorization Level (Routine / Urgent / All)
- Sections Covered
- Date Authorized
- Date Authorization Expires
- Specimen Signature
- Comments
Instructions on the form
- This list must be reviewed and updated at least annually and upon any changes in authorized personnel.
Sign-off
- Completed by
- Reviewed by
Related templates
- List of Persons Authorized to Receive Test Reports (PR14-F02)
- List of Critical Results (alert Values) (PR14-F03)
- Critical Result Notification Log (PR14-F04)
- Guide: ISO 15189 documentation checklist
Clause references are to ISO 15189:2022; check them against your licensed copy of the standard.