Lumiform Mobile audits & inspections
Get App Get App

Laboratory Investigation Report

Use this template to investigate laboratory misconduct or accidents. Note who was responsible and the date and time of the incident on the report. Was the right lab equipment used? Did the attendant follow the correct protocol and procedure? Get to the root cause of the problem, and answer all these questions and more on the form below.

Downloaded 32 times
Event Informarion
Material / Product:
Lot No.
Method No: / Rev. / Method Tittle / Effective Date
Initial Result
Test Date:
When the event was detected (Date of Occurence):
Description of Event (What Happened):
The data generated is accurate (i.g. System Suitability was within specifications, elements of the analysis were found correct)
Type of Result
Inmediate Correction:
Initial Impact Assesment (What is the extention of the event)
Laboratory Investigation:
Analyst Evaluation
The analyst that perform the analysis was qualified to perform the analysis?
The analyst has experience in the analysis (He/She performed the test on the past)?
Standard Preparation Evaluation
The Standard Weight are correct?
The Glassware used was correct
Standard preparation reference:
The standard preparation was performed as per method instructions?
Sample integrity
Was the sample received in the correct container
Did the sample came in a bag with desicant?
The sample was stored in the correct area (Document the area of storage (If applicable document the humidity of the room)
Sample Preparation Evaluation:
The sample was received in the appropriate container
The glassware used in the analysis is correct (i.g. volumetric flask, pippets, etc)?
The sample weight performed was correct?
The solution used for the sample preparation is correct (Reference)
Evaluate the sample preparation against the method instruction with the analyst. That any deviation or error was found?
Re-measutements was performed?
Results of re-measurements
The original result was confirmed??
If the OOS was confirmed, open and investigation to other area (i.g. Mfg, MTDP etc) to expand the investigation process. Refer to:Root
Instrument Evaluation
Instrument used
Calibration Due Date:
The instrument was verified and it was detected an error (i.g leak, error message, etc)
All the instrument parameters were correct (No error message or equipment malfuntion was detected)
Re-Test Performed?
Re-Test Results (Document)
Did re-test results confirmed the original results
Trending Evaluation
Evaluate the history the previous year and document the findings
Root Cause
Laboratory Root Cause
Trackwise Root Cause
Correction or Corrective Action
Action Taken
Preventive Action (This prevent the recurrence of the root cause identified)
Action Taken
Final Conclusion
Describe the results that will be used as official to report the test.
Share this template:

This post is also available in: Deutsch Español

Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
This site is registered on as a development site. Switch to a production site key to remove this banner.