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Photograph of Aspergillus niger spores.Multiple Environmental Test Sample Chain of Custody Form
Asbestos, Dust, Fiberglass, Paint, Mold or Other Particle Tests

Environmental sample or mold test chain of custody form:

Here we provide a free chain of custody form that readers can use to send environmental samples to any laboratory including our own.

InspectAPedia tolerates no conflicts of interest. We have no relationship with advertisers, products, or services discussed at this website.

- Daniel Friedman, Publisher/Editor/Author - See WHO ARE WE?

Chain of Custody Form for Mold, Dust, Environmental Samples

Envronmental Sample Chain of Custody Form InspectAPedia.com®
© 1986-2021 Daniel Friedman

PRINTER FRIENDLY CHAIN of CUSTODY FORM for SAMPLES [PDF]

BULK SAMPLES: email your test lab first to discuss sampling, packaging, processing, & fees

Environmental Testing, Paint Analysis, Art Conservation, Forensic Particle Identification, Indoor Air Investigations, Bioaerosols, Pollen, Mold, Mildew, Moisture. Mold Sampling & Laboratory Analysis

MAIL TO: [Mail this form with your sample to an environmental test lab of your choice. DO NOT send your sample to us without prior agreement.]
_______________________________________

_______________________________________

_______________________________________


(C) D Friedman, American Industrial Hygiene Association AHIA #149982 - Website: InspectAPedia.com®

Field Sample Chain of Custody

Client Name & Address to mail report

Site of Sample Collection

Collection Date

Address

Address

Project#

 

 

On Site From

 

To

 

 

Tel

Tel

Site Conditions

Email

 

Collected by

Received by

Processed by

Signature -  Date

Signature – Date

Signature – Date

 

Location

HE=high exposure/complaint area

LE=Low exposure/complaint area
Use one table  row to describe each sample.

Type
A__Air/L3 V=Vac T=Tape  B=Bulk  S=Swab-in2

Process

Hold

 

Description / Comments

 

Accom-panying

Field

Photo

#

-1

 

Check one

HE__

LE__

 

 

 

 

 

-2

 

 

HE__

LE__

 

 

 

 

 

-3

 

 

HE__

LE__

 

 

 

 

 

-4

 

 

HE__

LE__

 

 

 

 

 

-5

 

 

HE__

LE__

 

 

 

 

 

-6

 

 

HE__

LE__

 

 

 

 

 

How to Collect & Mail Environmental Samples

FORENSIC LAB SAMPLE PROCESSING AVAILABILITY NOTICE: We are not accepting test samples at our lab except in limited pro-bono cases by prearrangement. We apologize for the inconvenience.

Also see TEST KIT for DUST, MOLD, PARTICLES: INSTRUCTIONS for tape sampling produces high quality surface samples of building dust, particle samples, mold or mold-suspect material, or other particles for identification by a qualified laboratory.

MULTPLE ENVIRONMENTAL SAMPLES CHAIN of CUSTODY FORM - PRINTER READY [PDF] to number, identify, & describe your samples

Asbestos testing samples will typically be a bulk sample, a piece of asbestos-suspect material, perhaps double-bagged in a Zip-Lok® bag or equivalent, properly collected.

Dust samples to be screened for asbestos, mold, or other environmental hazards may be collected using clear adhesive tape

Mold testing samples may be a bulk sample, a cut of drywall or a sample of mold-suspect insjulation, packaged as we just described.


...

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MULTIPLE ENVIRONMENTAL SAMPLES CHAIN of CUSTODY FORM at InspectApedia.com - online encyclopedia of building & environmental inspection, testing, diagnosis, repair, & problem prevention advice.


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