Laboratory Declaration 626c0cd6 d206 80db 4092 086651667097

2016 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: 22-Feb-16