Laboratory Declaration 2e8567e3 352b 7346 2637 d955428fe6cc

2015 DECLARATION This sheet MUST be signed and dated for every survey and retained for inspection. DO NOT COMPLETE PRIOR TO RECEIPT OF SURVEY MATERIAL As senior laboratory officer and laboratory director we certify that the survey material received was treated, as far as possible, in a manner similar to routine specimen processing in this laboratory. Furthermore, we declare that RCPAQAP results have been reviewed and discussed with relevant staff.

Cytopathology Surveys Survey

Senior Laboratory Officer Signature

Laboratory Director Signature

Date

Survey 1 Receipt Review

Survey 2 Receipt Review

Survey 3 Receipt Review

Survey 4 Receipt Review

Document No: Version No:

QF-CY-25 3

Laboratory Declaration

Page 1 of 1 Printed: 5-Mar-15