InfoCard #: STCL-FORM-073 Rev. 01 Effective Date: 01 Nov 2018
STEM CELLLABORATORY (STCL)
DOCUMENT NUMBER: STCL-FORM-073
DOCUMENT TITLE:
C02 Incubator Plate Inspection Log
DOCUMENT NOTES:
Document Information
Revision: 01 Vault: STCL-Form-rel
Status: Release Document Type: STCL FORM
Date Information
Creation Date: 18 Oct 2018 Release Date: 01 Nov 2018
Effective Date: 01 Nov 2018 Expiration Date:
Control Information
Author: WATE02 Owner: WATE02
Previous Number: None Change Number: STCL-CCR-433
CONFIDENTIAL - Printed by: ACM93 on 01 Nov 2018 08:14:14 am
InfoCard #: STCL-FORM-073 Rev. 01 Effective Date: 01 Nov 2018
Stem Cell Laboratory
Equipment:SN:Location:MonthA^ear:
STCL-FORM-073C02 INCUBATOR PLATE INSPECTION LOG
. = OK or function performed NP = Not Performed Record problem and corrective action on reverse side
DAILY:
ALL plates storedin the TOPCHAMBERwere inspectedfor contaminationor film
Initials
DAILY:
ALL plates storedin the BOTTOMCHAMBER
were inspectedfor contaminationor film
Initials
(S m -r IT- ^0 r~ ao 0\0 r^ 1^ -r IT. ^0 r~ ao 0^ 0
(S N s a s IT.N ^ K so
d s ? m
Weekly Review: (Initials/Date)Wkl
Monthly Review (Date/Initial):
Wk2 Wk3 Wk4 Wk5
NOTE: Each CPU assay plate, stored in the CO; Incubators, was inspected to ensure there was NO visible contamination or film on the bottom of the plates. If a problem is noted, please notifysenior staff immediately and record information on the troiibleshooting log so investigation and/or corrective action can be initiated ASAP to minimize the number of samples that are impacted."STCL-FORM-073 C02 Incubator Plate Inspection LogStem Cell Laboratory, DUMCDurham, NC
CONFIDENTIAL - Printed by: ACM93 on 01 Nov 2018 08:14:14 am Page 1 of 1
InfoCard #: STCL-FORM-073 Rev. 01 Effective Date: 01 Nov 2018
Signature Manifest
Document Number: STCL-FORM-073
Title: C02 Incubator Plate Inspection Log
Revision: 01
All dates and times are in Eastern Time.
STCL-FORM-073 C02 Incubator Plate Inspection Log
Author
Name/Signature Title Date Meaning/ReasonBarbara Waters-Pick(WATE02)
Manager
18 Oct 2018, 06:36:18 PM Approved
Name/Signature
Barbara Waters-Pick(WATE02)
Medical Director
Title Date Meaning/Reason
18 Oct 2018, 06:36:31 PM Approved
[ Name/Si^gnatureJoanne Kurtzberg(KURTZ001)
Title I Date ! Meaning/Reason
18 Oct 2018, 09:22:08 PM Approved
Quality
Name/Signature
Richard Bryant (RB232)
Document Release
I Name/Signature
Title
Title
Date
19 Oct 2018, 07:45:58 AM
Date
Meaning/Reason
Approved
Meaning/Reason
Sandy Mulligan (MULL1026) 23 Oct 2018, 05:16:07 PM Approved
CONFIDENTIAL - Printed by: ACM93 on 01 Nov 2018 08:14:14 am