Example Instructions for Urine and Water Collection

Attachment I

Example Urine Specimen and Water Sample Collection

Form Approved

OMB No. 0920-XXXX

Exp. Date xx/xx/20xx

Collecting and storing a urine sample

You should:

• collect your urine sample in a completely clean (sterile) container

• store it in a fridge, in a sealed plastic bag, if you can’t hand it in straight away

Collecting a urine sample

Your doctor or another healthcare professional should give you a container and explain how you should collect the urine sample. 

You can collect a urine sample at any time of day, unless your GP or practice nurse advises you otherwise.

The types of urine sample you might be asked for include a random specimen, first morning specimen or timed collection.

To collect a clean urine sample:

• label the container with your name, date of birth and the date

• wash your hands 

• start to urinate, but don’t collect the first part of urine that comes out

• collect a sample of urine "mid-stream" (see below) in a sterile screw-top container

• screw the lid of the container shut

• wash your hands thoroughly

If your doctor gives you any other instructions, follow these.

What is a mid-stream urine sample?

A mid-stream urine sample means that you don’t collect the first or last part of urine that comes out. This reduces the risk of the sample being contaminated with bacteria from:

• your hands 

• the skin around the urethra (tube that carries urine out of the body) 

Storing a urine sample until you hand it in

CDC estimates the average public reporting burden for this collection of information as 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Ga. 30333; ATTN: PRA (0920-xxxx).

If you can’t hand your urine sample in within an hour, you should keep it in the fridge at around 4C (39F) for no longer than 24 hours. Put the container of urine in a sealed plastic bag first.

Reference available online: http://www.nhs.uk/chq/Pages/how-should-i-collect-and-store-a-urine-sample.aspx?CategoryID=69&SubCategoryID=692 (accessed 2 March 2016).

Collecting a tap water Sample

VERMONT DEPARTMENT OF HEALTH LABORATORY

195 COLCHESTER AVENUE, BURLINGTON, VT 05402-1125

(800) 660-9997 or (802) 863-7336

INORGANIC CHEMICAL SAMPLING INSTRUCTIONS

Please read prior to collection of sample. If these instructions are not followed closely it may result in the analysis being delayed or the sample being rejected.

The kit will contain the required forms and containers for the tests ordered:

One Water Sample Collection Information Form (Chem 202)

One, 1-liter pre-cleaned plastic container (for Kit C, Kit IA, Kit ID or Single Tests)

One, 500mL Glass bottle with Bubble Wrap (for Odor Test, Kit ID or Alkalinity test)

One, 125mL pre-cleaned plastic container (for Nitrate/Nitrite/Sodium/Chloride or a Single Test)

Regulated Water Systems Only: The sample must be taken at the point of entry to the distribution.

a) If the system is served by surface water the sample must be taken after any application of treatment.

b) If the system is served by ground water the sample must be taken at a location representative of each source after any application of treatment.

The sample should be taken from an indoor faucet in a clean area such as a kitchen sink. Collect the sample from the cold water faucet where you usually obtain your drinking water.

SAMPLING INSTRUCTIONS

1. Remove the aerator and run the water for 3-5 minutes to flush pipes before taking samples. Rinsing the pre-cleaned containers is not necessary.

2. To eliminate contamination, keep containers closed until ready to use and do not touch the inside of the cap or the mouth of the container.

3. For an Odor or Alkalinity test, fill the glass bottle completely to the top with no headspace or air bubbles.

4. All other containers may be filled up to the neck of the bottle or to within one-inch (1") from the top.

5. Tighten all caps firmly to prevent leakage. If multiple samples are being submitted, label the samples so they can be identified from others (i.e., name and sample location)

6. Place the glass bottles back into the foam jackets provided with bubble wrap to prevent breakage during transit.

7. Complete Water Sample Collection Information form (Chem 202). Be sure the DATE and TIME of sample collection is filled out. Describe any water treatment in Sampler’s Remarks section (e.g. water softener).

STORAGE and SHIPPING

1. After filling the containers, samples should be kept cool (in a refrigerator or a cooler) and delivered to the laboratory as soon as possible. Some tests (pH, residual chlorine, odor, nitrite and nitrate) need to be received within 24 hours. Most other tests need to be received within 48 hours. Test results may be qualified if sample has no evidence of cooling upon arrival at the laboratory.

Samples can be hand delivered Monday through Friday from 7:45am to 4:30pm. Samples for a Nitrite test must be received by 12:00 Noon on Friday to meet test requirements. If mailing samples, collect the sample just prior to mail pick-up at your post office. We highly recommend ‘next day delivery’ service.

Reasons a sample may be rejected include: Incomplete Water Sample Collection Information form (Chem 202), the use of a non-VDHL container or if received greater than 48 hours from the time of collection.

NOTE: Oxidizers such as Chlorine interfere with Nitrite testing and if an oxidizer is present, the sample may be rejected or the result qualified.

A full test report will be mailed to you upon completion of analysis & review, usually 14 to 21 days.

If you have questions regarding these instructions, please call (802) 863-7336 OR (800) 660-9997. Thank you!

CHEM 402 Rev 3 October 2012

Reference available online: http://www.healthvermont.gov/enviro/water/documents/KitCetc.pdf (accessed 2 March 2016).