Observe blood and urine collection procedures on at least one applicant

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1. Name of Contractor Completing Survey: (Required.)

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2. Are blood and urine collected onsite?

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3. Barcodes or unique lab IDs used instead of names. (Required.)

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4. Proper PPE used during specimen collection procedures. (Required.)

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5. Hand hygiene is conducted before and after applicant care. (Required.)

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6. Samples are stored appropriately and, if needed, transported appropriately. (Required.)

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7. Sharps are disposed of in a WHO approved sharps container. (Required.)

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8. Applicants are accompanied to restrooms used or urine collection. (Required.)

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9. Applicant’s belongings and family are prohibited in the restrooms used for urine collection. (Required.)

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10. Urine sample is confirmed to be urine (e.g., temperature is monitored, toilet water is dyed blue, etc.) (Required.)

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11. List the average turnaround times for the following tests: (Required.)

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12. Additional comments on specimen collection procedures (open comment): (Required.)

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