Biological Sample Collection Log

PrtApndxC1_BloodCollctnLog 20181012.docx

Per- or Polyfluoroalkyl Substances Exposure Assessments (PFAS EAs)

Biological Sample Collection Log

OMB: 0923-0059

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Appendix C1.

PFAS Exposure Investigation, blood and urine sampling

[INSERT SITE LOCATION, STATE]

Biological Sample Collection Log



Date

Time

Participant Name

Participant ID#

(place label here)

Phlebotomist

Was Urine Sample Provided?

Notes

























File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorWorley, Rachel R. (ATSDR/DCHI/SSB)
File Modified0000-00-00
File Created2021-01-20

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