Proficiency Test Corrective Action Checklist

07Department _____________________________ Evaluation Date ___________________Proficiency Survey_________________________ Test & Specimen number_________________Reported Results____________ Expected Results____________ Acceptable Range___________

Investigation of Unacceptable Results	Yes	No	N/A
Was the assay repeated?
Was the repeated result within the acceptable range?
Was QC acceptable on day of test?
Was QC free of drifts or trends?
Have errors occurred with this analyte in the last 2 surveys?
Were the survey specimens acceptable when received?
Were the specimens handled properly before & during testing?
Did a time delay occur between reconstitution & analysis?
Were the specimens mixed-up?
Was a pipetting or dilution error made?
Did any instrument or reagent problems occur on the day of testing?
Had assay calibration been performed as required?
Had instrument maintenance been performed as required?
Were instrument parameters entered correctly?
Were the results within the linear range?
Was the correct instrument code entered in the survey?
Was a transcription error made?
Was a transposition error made?
Was a calculation error made?
Were results misinterpreted or misidentified?

Investigation of bias, trends or miscellaneous findings

Conclusion: Corrective Action Taken: Investigated by:_________________________________________ Date____________ Manager:______________________________________________ Date____________ Pathologist ____________________________________________ Date____________

Last Updated on Thursday, 07 April 2011