Shipping Manifest Form PDF Details

Navigating through the requirements of the Chemical Exposure Clinical Specimen Shipping Manifest can seem daunting, but it's a critical step to ensure safety and compliance with the Massachusetts Department of Public Health protocols. Used specifically when sending clinical specimens that might have been exposed to chemical agents, this form acts as a direct communication link between the sender and the William A. Hinton State Laboratory Institute. Filling out the form accurately is essential, as it includes comprehensive sections on general information, shipping details, contact points, and specific specimen information. Key fields require the sender's details, shipping timings, contacts for primary and secondary submitters, the total number and type of specimens, and precise shipping address information. Moreover, special instructions highlight the necessity of securing the form in a zip-loc bag atop the secondary container within the Styrofoam package. Crucially, prior communication with the receiving laboratory is advised to ensure the preparedness and correct handling upon arrival. This detailed manifest serves not just as a procedural requirement but as a vital safety measure in the handling and transportation of potentially hazardous materials.

QuestionAnswer
Form NameShipping Manifest Form
Form Length2 pages
Fillable?Yes
Fillable fields255
Avg. time to fill out25 min 47 sec
Other namesclinical specimen manifest sample, delivery manifest template, blank shipping manifest, transport manifest template

Form Preview Example

Massachusetts Department of Public Health

William A. Hinton State Laboratory Institute

Chemical Terrorism Response Laboratory

305 South Street, Jamaica Plain, MA 02130

Tel: 617-983-6650 Fax: 617-983-6662

CHEMICAL EXPOSURE CLINICAL SPECIMEN SHIPPING MANIFEST

DIRECTIONS: Please fill out this form completely and put in a zip-loc plastic bag. Place the bag on top of the

secondary container. Please use one form per shipping container.

GENERAL INFORMATION:SHIPPING INFORMATION:

Shipped By:______________________________________Time: __________AM / PM (circle one)

Address: ________________________________

Date: ____/____/_______

 

 

 

 

 

 

 

 

 

 

 

 

CONTACT NAMES:

 

CONTACT TELEPHONE NUMBERS:

Primary:

 

 

 

Primary: ______-_________________

Title:

 

 

 

Fax:

______-_________________

Secondary:

 

 

 

 

Title:

Emergency ______-_________________

SPECIMEN INFORMATION:

1.Total number of specimens __________

2.Indicate which type of specimen is being shipped (only check one):

Blood (refrigerated) with refrigerator packs

Urine (frozen) with dry ice

Comments:

____________________________________________________

____________________________________________________

SHIP TO: Massachusetts Department of Public Health William A. Hinton State Laboratory Institute 305 South Street

Jamaica Plain, MA 02130

Attn: Dr. Jennifer Jenner, CT Coordinator 617-983-6650 (lab) / 617-839-1283 (cell)

PS-CT-3-08

MARCH 2009

Massachusetts Department of Public Health

William A. Hinton State Laboratory Institute

Chemical Terrorism Response Laboratory

305 South Street, Jamaica Plain, MA 02130

Tel: 617-983-6650 Fax: 617-983-6662

Filling out Chemical Exposure Clinical Specimen Shipping Manifest

One form should be used for each secondary container.

The form should be put in a ziplock plastic bag and placed on top of the secondary container located inside the Styrofoam container.

General Information

The name and address of the agency shipping the specimens, including contact

Shipping Information

The time and date that the package was shipped

Contact Names

The name and title of the submitter and an alternate, if applicable

Contact Telephone Numbers

Provide telephone, fax, and/or emergency numbers that the submitter can be reached. If the package is breached during transit or the receivers have questions about the specimens, it is very important to be able to contact the submitter immediately.

Specimen Information

Indicate the total number and type of specimens (urine or blood) in the secondary container.

Shipping Address

Because it is very important to have the correct and complete address of the receiver; please use the complete SHIP TO address provided on the shipping manifest.

Please remember to call the receiver BEFORE sending specimens, so they can know 1) when to expect the package and 2) who is delivering the package.

If you have any questions, please call the telephone number provided above.

PS-CT-3-08

MARCH 2009

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shipping manifest forms conclusion process outlined (portion 1)

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Step no. 2 in filling out shipping manifest forms

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