Sample Rejection 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 Rejection Log | YL-LAB-LOG-20-F02 v1.0
Record: Sample Rejection Log — October 2026
| No. | Date | Accession No. / Sample ID | Patient Name / ID | Rejection Reason | Test Requested | Rejected by | Clinician / Ward Notified? | Repeat Sample Requested? (Y/N) | Date Repeat Received | Resolved? (Y/N) | Comments |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2026-10-01 | S26-1041 | S. Dlamini | Glucose | S. Dlamini | Y | 2026-10-01 | Y | Within limits | ||
| 2 | 2026-10-08 | S26-1048 | A. Mensah | Creatinine | A. Mensah | Y | 2026-10-08 | Y | |||
| 3 | 2026-10-15 | S26-1055 | L. Banda | ALT | L. Banda | Y | 2026-10-15 | Y | |||
| 4 | 2026-10-22 | S26-1062 | K. Otieno | Haemoglobin | K. Otieno | N | 2026-10-22 | N | Within limits | ||
| 5 | 2026-10-29 | S26-1069 | T. Moyo | Potassium | T. Moyo | Y | 2026-10-29 | Y | |||
| 6 | 2026-11-05 | S26-1076 | R. Naidoo | Glucose | R. Naidoo | Y | 2026-11-05 | Y | |||
| 7 | 2026-11-12 | S26-1083 | S. Dlamini | Creatinine | S. Dlamini | Y | 2026-11-12 | Y | Within limits | ||
| 8 | 2026-11-19 | S26-1090 | A. Mensah | ALT | A. Mensah | Y | 2026-11-19 | Y |
Total Rejections8
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
- Accession No. / Sample ID
- Patient Name / ID
- Rejection Reason
- Test Requested
- Rejected by
- Clinician / Ward Notified?
- Repeat Sample Requested? (Y/N)
- Date Repeat Received
- Resolved? (Y/N)
- Comments
Sign-off
- Completed by
- Reviewed by
Related templates
- Specimen Acceptance Criteria (reference Card) (PR20-F01)
- Oral Request Form (PR20-F03)
- Sample Acceptance Exceptions Log (PR20-F04)
- 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.