How To Fill Out Chain of Custody

Click to download the Chain of Custody Form

Click the section to read about how to fill it out

Section 1: Client and Job Information

1. Client Job No: (Optional) The number that you have given to this job. Usually a unique number.
2. Project Name: (Optional) The name that you have assigned to this job. Usually a unique name.
3. Company or Client Name: (Required) This is your name or your business’ name. It will be printed on the final report as the company involved.
4. Contact Information: (Required) We require your phone number as a contact. If you would like us to fax or email the results to you, we will also require this information.
5. Address: (Required) Your company’s address or your home address.
6. Contact Name and Invoice to: (Required) Contact name is your name or the name of the person that you want on the report. Invoice contact is the name that will go on the invoice, if different from the regular contact.
7. Help with results interpretation: If you would like additional interpretation on the report itself, choose ‘yes’.
8. Any special instructions: If additional instructions are needed (such as ‘please return sample to me after it has been analyzed’) or additional information is available (such as a PO number), please fill it out here.

Section 2A: Sample Information and Specifications

9. Client Sample ID: (Required) This is the number or identification you give to a sample. It is a unique identifier.
10. Date Collected: (Required) The date that you collected the samples on.
11. Sample Type: (Required) The type of sample (i.e., Air-O-Cell, Versatrap, Bulk, Tapelift, RCS Agar, Swab, etc)
12. Sample Location/Description: A description (this will go on the report) of the sample (ie. Bedroom, Garage ceiling, Wallpaper from bathroom, etc)
13. Sample details: Air samples are taken for a particular time at a particular flow rate. Both of this information is needed for the report. If quantification is required for swab or dust samples, the surface area swabbed (or the mass of the dust) is needed.

Section 2B: Sample Type and Analysis Information

14. Turnaround Time Required: (Required) “S” is standard turnaround (1-3 business days for most sample types, excluding those which involve culturing), “R” is rush turnaround (within 1 business day), and “H” is holiday service, which includes both holidays and weekends.
15. Analysis type requested: (Required) These are the options:
    • Bulk, tapelift, dust, and swabs: DME — this is normal, non-culturing analysis for samples that are not air sample cassettes.
    • Bulk, dust, and swabs: culture — this is culture analysis for non-air samples, without quantification.
    • Air: Non-viable analysis (e.g. Air-O-Cell) — this is analysis of air sampling cassettes.
    • Air:Viable analysis (eg RCS) — this is culture analysis of culturable air samples (e.g., Anderson samples and RCS samples).
    • Dust, swabs: culture quantification — culturing and quantifying of non-air samples (note that the area swabbed must be known).
    • Dust, swabs: culture no quantification — culturing of non-air samples (no quantification).
    • Other: anything not explicitly listed here

Section 3: Authorization and Signatures

16. Relinquished by: (Required) This section is filled out by each person that deals with with Chain of Custody. The person taking the samples must fill it out and sign it, then each person that deals with it thereafter must fill it out and sign it.
17. Testing Authorized by: (Required) An authorizing signature must be on the form for the samples to be analyzed. Please print your name, sign and date the form.

If you have questions about completing the chain of custody documentation or would like additional information on our bacteria and mold testing services, please contact us using the form below.