PT Troubleshooting Checklist
PT Troubleshooting Checklist
PT Troubleshooting Checklist
Investigation Worksheet
Survey Information
Unacceptable Result 1
Specimen Number: Analyte:
Reported Result: Intended Result/Range:
Unacceptable Result 2
Specimen Number: Analyte:
Reported Result: Intended Result/Range:
Unacceptable Result 3
Specimen Number: Analyte:
Reported Result: Intended Result/Range:
Unacceptable Result 4
Specimen Number: Analyte:
Reported Result: Intended Result/Range:
Unacceptable Result 5
Specimen Number: Analyte:
Reported Result: Intended Result/Range:
Was the result correctly transcribed from the instrument read-out or report?
Was the correct instrument/method/reagent reported on the result form?
Do the units of measure match between the result form and the instrument results?
Is the decimal place correct?
Does the result reported on the result form match the result found on the proficiency testing
evaluation report?
A response of “No” to any of these questions may indicate a clerical error. Although reporting of proficiency testing results
is unlike those for patient results, clerical errors may indicate a need for additional staff training, review of instructions
provided with the proficiency testing, addition of a second reviewer, or investigation of the reporting format provided by the
testing device. If results reported on the result form do not match the results found on the evaluation report, please
contact your proficiency testing provider.
5607 November 2015
Procedural YES NO N/A
Was the written procedure followed?
Were the reagents prepared according to procedure?
Were the reagents within their open stability acceptable range?
Were Quality Control results acceptable and without bias?
Were microscopic examinations interpreted correctly?
Was culture media stored per manufacturer's instructions?
Was staining performed and interpreted correctly?
Were dilutions performed correctly?
Were calculations performed correctly?
A response of “No” to any of these questions may indicate a procedural error. These errors indicate inappropriate
operation of equipment or performance of a method. A review of the instructions provided with the proficiency testing
material and/or review of laboratory procedures may be required.
Conclusion/Summary:
Review/approval:
Date: