CoCForm_Ext-Orgs.qxd
14/04/2004
5:51 PM
Page 1
CHAIN OF CUSTODY FORM
1. DOPING CONTROL SESSION
DCO NAME TEST LOCATION OUT OF COMPETITION IN COMPETITION TEST MISSION CODE CITY STATE COUNTRY
TEST AUTHORISED BY
AUTHORISED COLLECTION AGENCY
NUMBER OF SAMPLES TIME SESSION COMPLETED
URINE
BLOOD
SPORT
DATE
DD MM YYYY
2. SAMPLE ID
A/B A/B A/B A/B A/B
3.TRANSPORTATION AND STORAGE
FROM (LOCATION)
A/B A/B A/B A/B A/B
A/B A/B A/B A/B A/B
TO (LOCATION) ARRIVAL DATE DEPARTURE DATE DCO SIGNATURE DCO SIGNATURE ARRIVAL TIME DEPARTURE TIME
DATE
DD MM YYYY
TIME
DD
MM
YYYY
DD
MM
YYYY
TO (LOCATION) ARRIVAL DATE DEPARTURE DATE DCO SIGNATURE ARRIVAL TIME DEPARTURE TIME
TO (LOCATION) ARRIVAL DATE DEPARTURE DATE DCO SIGNATURE ARRIVAL TIME DEPARTURE TIME
DD
MM
YYYY
DD
MM
YYYY
DD
MM
YYYY
DD
MM
YYYY
TO (LOCATION) ARRIVAL DATE DEPARTURE DATE DCO SIGNATURE ARRIVAL TIME DEPARTURE TIME
TO (LOCATION) ARRIVAL DATE DEPARTURE DATE DCO SIGNATURE ARRIVAL TIME DEPARTURE TIME
DD
MM
YYYY
DD
MM
YYYY
DD
MM
YYYY
DD
MM
YYYY
4. DCO TRANSFER TO LABORATORY, COURIER OR OTHER
DCO NAME DATE
DD MM YYYY
DROP-OFF TIME
IF TRANSFERRED TO LABORATORY
LAB REP . NAME LAB REP . POSITION LAB REP . SIGNATURE
IF TRANSFERRED TO COURIER
COMPANY NAME WAYBILL NUMBER COURIER SIGNATURE
IF TRANSFERRED TO OTHER
OTHER NAME OTHER POSITION OTHER SIGNATURE
ORIGINAL - ADO - WHITE
COPY 1 - AUTHORISED COLLECTION AGENCY - GREEN
COPY 2 - LABORATORY - YELLOW
VERSION 2: 04-2004 (WADA/AMA)