Sample Acceptance Exceptions Log template
A log in the Pre-examination and Sample Handling procedure (PR20), mapped to ISO 15189:2022 clause 7.2. Fill it in monthly. Used by the laboratory team.
LogISO 15189 · 7.2Monthly
Calculated automaticallyRed = outside limits
Your LaboratorySample Acceptance Exceptions Log | YL-LAB-LOG-20-F04 v1.0
Record: Sample Acceptance Exceptions Log — October 2026
Use this form when a compromised sample is accepted under exceptional circumstances. Note exception on final report.
| No. | Date | Sample ID | Patient Name / ID | Compromise Category (Wrong ID/Instability/Temp/Container/Volume) | Description of Compromise | Clinical Justification for Acceptance | Authorised by | Patient Risk Assessed? (Y/N) | Noted on Report? (Y/N) | NC Opened? (Y/N) | Comments |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2026-10-01 | S26-1041 | S. Dlamini | 22.50 | Monthly QC review | R. Naidoo | Y | Y | Y | Within limits | |
| 2 | 2026-10-08 | S26-1048 | A. Mensah | 23.70 | Equipment maintenance | S. Dlamini | Y | Y | Y | ||
| 3 | 2026-10-15 | S26-1055 | L. Banda | 23.10 | Document review | A. Mensah | Y | Y | Y | ||
| 4 | 2026-10-22 | S26-1062 | K. Otieno | 21.30 | Competency assessment | L. Banda | N | N | N | Within limits | |
| 5 | 2026-10-29 | S26-1069 | T. Moyo | 22.40 | Monthly QC review | K. Otieno | Y | Y | Y | ||
| 6 | 2026-11-05 | S26-1076 | R. Naidoo | 21.30 | Equipment maintenance | T. Moyo | Y | Y | Y | ||
| 7 | 2026-11-12 | S26-1083 | S. Dlamini | 21.40 | Document review | R. Naidoo | Y | Y | Y | Within limits | |
| 8 | 2026-11-19 | S26-1090 | A. Mensah | 23.90 | Competency assessment | S. Dlamini | Y | Y | Y |
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
- Date
- Sample ID
- Patient Name / ID
- Compromise Category (Wrong ID/Instability/Temp/Container/Volume)
- Description of Compromise
- Clinical Justification for Acceptance
- Authorised by
- Patient Risk Assessed? (Y/N)
- Noted on Report? (Y/N)
- NC Opened? (Y/N)
- Comments
Instructions on the form
- Use this form when a compromised sample is accepted under exceptional circumstances. Note exception on final report.
Sign-off
- Completed by
- Reviewed by
Related templates
- Specimen Acceptance Criteria (reference Card) (PR20-F01)
- Sample Rejection Log (PR20-F02)
- Oral Request Form (PR20-F03)
- Sample Retention Schedule (PR20-F05)
- Sample Requirements, Transport Systems and Method Review Form (PR20-F06)
- Guide: ISO 15189 documentation checklist
Clause references are to ISO 15189:2022; check them against your licensed copy of the standard.