Chain Of Custody Form

One simple form covers it all – asbestos, mould, lead and other substances for which you might need testing.

Download. Fill It Out Online, Print and Sign. Save a Copy.
Submit with Your Samples.

(See below for instructions)

What Is “Chain Of Custody”?

The Chain of Custody is a form that gives us:

  • Legal permission to process your samples
  • Information on where to deliver your results
  • Information about your samples
  • A variety of other sample-related details

Sample results aren’t meant for just anybody who walks in off the street—they’re meant for you. The Chain of Custody keeps sample results organized and legal, which is very important if—for instance—you need a building to be certified as Asbestos Free.

Filling Out The Chain Of Custody

Some customers don’t know how to fill out the Chain of Custody. But don’t feel bad—if you haven’t done it before it can be intimidating. This page will show you how to fill out the form by breaking down each part of the page using screenshots.

Here is a sample Chain of Custody form here so you can see what a completed form looks like.

To help speed up the process, we’ve made the form fillable on-screen, and with two simple clicks, you can print and sign the form(s) to include with your samples, and then save to your computer.

Come to the lab if you’re still having trouble; we’ll help you fill it out. Anyone should be able to have their samples tested, whether you’re a consultant who tests twenty samples a week or a homeowner who is doing their renovation and needs only one. You don’t have to be an expert to get expert results.

How To Fill Out
A Chain Of Custody Form

In 6 Easy Steps

1.
Client Information

Step 1

Enter all of your information into this part of the form.

step-2

Project Address – This is very important so we know where the sample(s) were taken. Don’t mistake this for your address, which is entered above.

Project Number – House / unit number, or your own project identifier

2.
Results Submission

step-3

Your results will be delivered by phone, FAX or email. You can even choose them all by checking off all three boxes—be sure to include alternate numbers and/or email addresses if they are different from the main contact information.

3.
Sample Details

step-4

Sample Name and Number – It can be something like “A-1”, “B-1” or “Floor-1”. This needs to match the labels on your Ziploc bags, because it’s how we’ll be able to pair each sample with the appropriate description that comes next.

Here’s an example of how you might label your bulk samples:

  • B1 = Living room ceiling – popcorn ceiling
  • B2 = Dining room corner – drywall compound
  • B3 = Bathroom floor tiles – linoleum

Description – You’ll want to include Type of Sample and Sample Location. For air samples, also include Flow RateSample Time-On & Time-Off, and Volume (optional).

  • Type of Sample– Is this sample a piece of drywall mud, or a floor tile? Write down what it is here. For air samples, just put “Air”.
  • Sample Location– Examples of this would be “Upstairs Bathroom” or “Basement Bedroom”.
  • Flow Rate– This is the L/min at which you ran the air pump. NIOSH 7400 requires 2.5-16L/minute as the proper airflow. You can call us for an air-flow recommendation for your particular situation.
  • Sample Time-On & Time-Off– The time that you started the air pump. Example: “3:30pm-4:45pm”
  • Volume (optional)– You may want to manually calculate the volume that went through the pump. If you ran the pump for 60 minutes at 10L/min, it would be “600L”.

Stop Pos. – Check this box if you want us to stop testing at the first positive result.

Sample Date/Time – Pretty self-explanatory.  Pick a date from the drop-down calendar and if known, the time the sample was taken (hour:minutes)

4.
Analysis and Turnaround Time (TAT)

step-5

Analysis Requested – Check off the type of analysis you need for each sample. For Asbestos, the most common types will be “BULK” and “AIR”.

  • BULK uses Polarized Light Microscopy (PLM).
  • AIR uses Phase-Contrast Microscopy (PCM).

Turnaround Time (TAT) – Check off the turnaround time that you need. For example, if you check off 24 hours, you’ll receive results within 24 hours of when we receive your sample during business hours.

If you need samples within 24 hours or less, please call ahead to let us know. If demand is very high, we may need to make arrangements to give you a quick turnaround time.

We can process a handful of samples per hour. Needless to say, we can’t process 30 samples within 60 minutes; so that’s why calling ahead of time for quick turnarounds is vital.

Call us for pricing on different turnaround times.

5.
Authorization & Signature

step-7
  • Authorized by– Person collecting the sample & making the payment.
  • Signature– Self-explanatory – sign here!
  • Sample(s) Collected By:This is a useful field if you have multiple people working through samples. If there’s a problem with the sample collection, we have a contact in case of questions about the sample or we can help you know which worker needs additional training in sample collection.

6.
Special Instructions, Print, Save and/or Email

step-8

Finally, if you have special instructions with regards to the requested testing or your samples, enter them here.

Click to print the form—blank or completed—for you or the authorized signatory to sign and attach to the samples, then click again to save the form to your computer and/or email it.

It’s that simple.

Using Multiple Chain Of Custody Forms

If you have more than 10 samples, feel free to attach one or more copy of the Chain of Custody to it. You can leave out the payment and client information on copies as long as they’re attached to the master form.  Please make sure you number the pages accordingly at the bottom right corner.

Sample Chain Of Custody Form

Not sure what a completed form looks like? View our sample form below so you can compare yours and make sure it’s done right.