List of Individualized Quality Control Plans Laboratories: Complete the fields below for each IQCP in use and present to the inspector during the on-site inspection. Laboratories with different CAP and/or CLIA numbers must complete separate forms. Inspectors: Refer to Inspector Instructions in the IQCP section of the All Common Checklist for instructions on identifying a sampling of IQCP records to review in detail. Laboratory CAP Name: Number: Instrument/Device Test Sites Tests Laboratory Section/ Include name, If used in more Date List all tests included Department manufacturer, model, and number of than one area under the IQCP instruments (if applicable)
List of Individualized Quality Control Plans Laboratories: Complete the fields below for each IQCP in use and present to the inspector during the on-site inspection. Laboratories with different CAP and/or CLIA numbers must complete separate forms. Inspectors: Refer to Inspector Instructions in the IQCP section of the All Common Checklist for instructions on identifying a sampling of IQCP records to review in detail. Laboratory Name: CAP Number: Laboratory Section/ Department Instrument/Device Include name, manufacturer, model, and number of instruments (if applicable) Tests List all tests included under the IQCP Test Sites If used in more than one area Date