Sample Chain of Custody Form Template for Product Trials
Summary
A trial sample custody and shipment record needs 6 sections: trial identity, sample register, controls and retains, shipment, handover log and deviations. Supplier technical staff and site custodians fill it during an industrial product trial, from the first sample drawn to laboratory receipt, so every result still traces back to its trial run, lot and sampling point.
ASTM D4840-99(2018)e1, an active ASTM guide written for water analysis, describes custody procedures that document sample possession during collection, shipment, storage and analysis (ASTM, 2018).
EPA New England's custody procedure has the person relinquishing and the person receiving samples sign, date and note the time on the record (EPA New England, 2002).
Under US Clean Water Act test procedures, the listed holding times are the maximum times a sample may be held before analysis starts and still be considered valid (40 CFR 136.3, Table II, eCFR 2026).
The US DOE Santa Susana custody procedure places two custody seals, signed and dated by the shipper, on opposite corners of every shipping container (US DOE, 2012).
Who uses a trial sample custody and shipment record, and when?
A trial sample custody and shipment record is used by the people who touch trial samples between the customer's line and the laboratory: the sampler, the site custodian who holds samples before dispatch, the supplier's technical owner of the trial, and the receiving custodian at the laboratory. The record is opened when the trial plan is issued, before the first sample is drawn, and closed when the laboratory has confirmed receipt of the last sample and the retained splits have been released or disposed of.
ASTM D4840, the ASTM guide to sample chain of custody, states the purpose of custody procedures as providing "accountability for and documentation of sample integrity from the time samples are collected until sample disposal" (ASTM, 2018). The guide was written for water analysis, so in a lubricant, coolant, water treatment or cleaner trial its elements apply as good practice rather than as a requirement. On the laboratory side, handling of test items falls under clause 7.4 of ISO/IEC 17025, the laboratory competence standard, whose 2017 edition ISO last reviewed and confirmed in 2023 (ISO, 2023). Australia's Therapeutic Goods Administration (TGA) laboratories, addressing that clause, assign a unique identification number as soon as they obtain custody and use it to link all associated documentation (TGA, 2025). The trial record ends where that laboratory record begins. The editable Word form and Excel log, with a CSV copy of the log columns, are at the end of this page.
Which sections does a trial sample custody record need?
A trial sample custody record needs six sections, and each field below is there because a missing value makes some trial result impossible to trace or read. The table previews every section and field of the template; the example values are illustrative and come from an invented coolant trial, not from a real case.
The six sections follow the path a sample takes. Trial identity ties the whole record to one trial plan, one product lot and one set of criteria fixed before sampling. The sample register gives each bottle an ID, a role and a holding time. Controls and retains pair every trial sample with its comparison and its recheck material. Shipment, handover log and deviations then record where custody went, in what condition the sample arrived, and what any departure from the plan did to each test. The Word form puts each section on its own numbered block; the Excel log flattens the sample, shipment and handover fields into one row per sample and handover, and deviations are written up in the Word form section 6.
Section or field | What goes in it | Unit | Example (illustrative) |
|---|---|---|---|
1. Trial identity: trial plan reference | Plan number and revision the samples serve | text | TP-2026-014 rev 2 |
1. Line, use and product under trial | Site, line, use, trial product lot, current product lot | text | Plant B, stand 3 emulsion; lot 26-0917 vs lot 26-0802 |
1. Laboratory and custodians | Testing laboratory, site custodian, receiving custodian | name | Supplier lab; site quality lead; lab sample desk |
1. Criteria freeze date | Date the trial criteria were fixed | YYYY-MM-DD | 2026-09-20 |
2. Sample register: sample ID | Unique ID, never reused in the trial | text | TP014-T-03 |
2. Role | Trial, control, baseline, retained split or blank | list | Trial |
2. Sampling point and method | Where and how the sample was drawn | text | Return tank tap after 2 min flush |
2. Collected | Date and time of collection | YYYY-MM-DD hh:mm | 2026-09-24 09:40 |
2. Quantity and container | Volume and container material | mL; text | 500 mL HDPE bottle |
2. Preservation | Cooling or additive applied | text | Cooled, no additive |
2. Holding time and latest analysis start | Time allowed by the test method or laboratory, and collection time plus that time | h; date-time | 72 h; 2026-09-27 09:40 |
2. Tests requested and sampler | Tests for this sample and who drew it | text | Concentration, pH, bacteria count; initials |
2. Container seal no. | Seal serial number on each trial, control and baseline container, if containers are sealed | text | S-104233 |
3. Controls and retains: paired control | Control or baseline ID and the trial sample it pairs with | text | TP014-C-03 pairs TP014-T-03 |
3. Same day, point type and method | Whether the control matches its trial sample | yes/no | Yes |
3. Retained split | Split ID, storage place and temperature | text; °C | TP014-T-03R, site fridge, 4 °C |
3. Keep until and who may open | Retention end date and the one person who may open it | date; name | 2026-12-31; site quality lead |
4. Shipment: shipment ID and packages | Shipment number and package count | text; count | SH-03; 1 cooler |
4. Package seals | Seal serial numbers on the package | text | S-104240, S-104241 |
4. Carrier and tracking | Carrier and tracking or airbill number | text | Courier; tracking number |
4. Transport classification | Classification taken from the product SDS | text | Not regulated for transport, per SDS |
4. Transport temperature | Required range and value measured on arrival | °C | 2 to 8 °C required; 5 °C measured |
4. Dispatched and due | Dispatch and expected arrival | date-time | 2026-09-24 14:00; 2026-09-25 10:00 |
5. Handover log: from and to | Releasing and receiving person and organization | name | Site custodian to courier |
5. Transfer time, purpose, place | When, why and where custody moved | date-time; text | 2026-09-24 14:05, dispatch, gatehouse |
5. Seal and condition on receipt | Seal intact, container condition, temperature | yes/no; text | Yes; sealed, no leak |
5. Signatures | Both parties sign | signature | Both signed |
6. Deviations: what happened | Number, sample IDs, event | text | D-04: TP014-T-05 arrived at 14 °C |
6. Effect on reading | Readable, readable with note, or not readable, per test | list | Bacteria count not readable |
6. Decision | Action, who decided, date | text | Resample next interval; trial owner; 2026-10-03 |
The holding time row is the field most custody forms leave out: it turns the collection time into a latest analysis start, so a late arrival is recorded as a deviation before anyone reads the number.
How do you record controls, retained samples and seals on a custody form?
Controls, retained samples and seals go on the same custody form as the trial samples, each with its own ID and a link to the trial sample it belongs to. A control or baseline sample is useful only if drawn on the same day, from the same point type and with the same method as the trial sample it is compared with, so the form records that pairing and a yes or no on whether the conditions matched.
Retained splits are recorded the way environmental programs record field splits. EPA New England uses field splits "to assess sample handling procedures from field to laboratory and laboratory's comparability" (EPA New England, 2002). For a trial, a retained split of each key sample stays sealed at the site, with its storage place and temperature, a keep-until date and the one person who may open it, so a disputed result can be rechecked.
Seal practice differs between published procedures, so record the one the trial plan chose. The US Department of Energy (DOE) Santa Susana procedure places custody seals on coolers, not on individual samples (US DOE, 2012). EPA New England places a seal on each individual container for enforcement samples (EPA New England, 2002). The California State Water Resources Control Board (SWRCB) guidance lists the serial number on seals and transportation cases among the field record entries (California SWRCB, 2010). Record every seal number, because a seal that cannot be matched to the form proves nothing on receipt.
How do you log each shipment and handover of a trial sample?
Each shipment of trial samples gets its own shipment entry, and each change of custody gets its own line in the handover log, signed by both the person releasing and the person receiving. EPA New England's procedure states that when possession is transferred, "the individuals relinquishing and receiving will sign, date, and note the time on the record" (EPA New England, 2002). The SWRCB guidance adds that every person who takes custody must fill in the appropriate section of the chain-of-custody record (California SWRCB, 2010).
The DOE Santa Susana procedure requires a separate chain-of-custody record with each shipment and the shipping number from the freight bill on that record (US DOE, 2012). It treats a sample in transit by a delivery or courier service as still under custody (US DOE, 2012). The SWRCB guidance says that receipts from a common carrier should be kept as part of the permanent custody documentation (California SWRCB, 2010).
Receipt is the handover that decides readability. The SWRCB guidance has the laboratory custodian log the person delivering, the person receiving, date and time received, how the sample was transmitted and the condition received, such as sealed, unsealed or broken container (California SWRCB, 2010). For trial samples, add the temperature on arrival when the trial plan sets a transport range. Before packing, take the transport classification from the product safety data sheet (SDS). If samples go by common carrier, the shipper must comply with the applicable transport rules, such as US Department of Transportation regulations for shipments in the United States (California SWRCB, 2010).
How do you fill in the trial sample custody record, field by field?
Fill in the trial sample custody record in the order the samples move, and complete each section before the samples leave the place where that section applies.
Before sampling, copy the trial plan reference, line, product lots, laboratory, custodians and criteria freeze date into section 1, and pre-print the sample register with every planned ID and role.
At the sampling point, fill in the collection date and time, quantity, container, preservation and sampler for each sample as it is drawn, and wear the protection the product SDS specifies.
Work out the latest analysis start for each sample: collection time plus the holding time from the test method or laboratory. US wastewater rules show the principle: for a grab sample, the holding time begins at the time of collection (40 CFR 136.3, Table II, eCFR 2026).
Before closing the cooler, write each container seal number in section 2 and fill in section 3: the paired control for each trial sample, the retained split, its keep-until date and its seal number.
At dispatch, fill in section 4 with the shipment ID, package seals, carrier, tracking number, transport classification and required temperature, and sign the first handover line.
At each handover, both parties sign the log line with date, time, purpose and place.
On receipt, the laboratory records seal condition, container condition and temperature, and returns a copy.
Record anything that departs from the plan in section 6 the same day, with its effect on each test.
What does an illustrative filled trial sample custody record look like?
An illustrative filled trial sample custody record for one invented coolant trial shipment shows how a single deviation is carried from the handover log into the deviations section. The trial, sample IDs, temperatures and times below are illustrative only, and the 2 to 8 °C transport range is an example value a trial plan might set, not a sourced limit.
The table below shows the handover log for illustrative shipment SH-05, which carried one trial sample and its paired control.
Transfer | From and to | Date and time | Seal and condition on receipt |
|---|---|---|---|
1. Collection to site store | Sampler to site custodian | 2026-10-01 09:50 | Container seal S-104301 applied |
2. Dispatch | Site custodian to courier, tracking number recorded | 2026-10-01 14:10 | Package seals S-104310, S-104311 intact |
3. Laboratory receipt | Courier to lab sample desk | 2026-10-02 16:30 | Seals intact; temperature 14 °C, above the 2 to 8 °C plan range |
4. Into testing | Lab sample desk to analyst | 2026-10-02 16:45 | Bacteria count put on hold |
Transfer 3 is the line that matters: the seals were intact, so custody held, but the arrival temperature was outside the illustrative plan range. The laboratory recorded deviation D-04 for trial sample TP014-T-05 and its control: concentration and pH readable with a note, bacteria count not readable. The trial owner decided on 2026-10-03 to draw a replacement pair at the next interval and to keep the original results in the file, marked as not for interpretation, so the decision was recorded before any result from the replacement pair was known.
Why do trial sample custody records fail?
Trial sample custody records fail mostly because they are started after sampling, kept on several forms, or missing the one field that would have shown a problem before results were read. The failures below come up in published custody guidance and apply to industrial product trials as well.
The record is opened at dispatch, so collection times and samplers are filled in from memory.
Controls travel on a separate form and are tested in a different batch from the trial samples.
The shipping or tracking number is never written down. The DOE Santa Susana procedure records the shipping number from the freight bill on the custody record (US DOE, 2012).
Seal numbers are not recorded, so an intact seal on receipt cannot be matched to the one applied.
No holding time is set, so a sample that sat over a weekend is tested and reported as normal.
An unattended sample or a refused signature is left unexplained. The DOE procedure requires that either be documented and explained on the record (US DOE, 2012).
A gap in the log is noticed only after a disappointing result. Contract Laboratory, writing for third-party testing laboratories, says chain-break indicators such as missing signatures, unrecorded transfers or damaged containers should trigger an internal investigation (Contract Laboratory, 2025).
Each failure is cheaper to prevent with a pre-printed register and a holding time per sample than to argue about once the trial result is on the table.
What should a trial sample custody record checklist cover?
A trial sample custody record checklist should confirm, before the first sample is drawn and again at dispatch, that every section can be completed from what is on site. Run it as a yes or no list; any no is fixed before sampling or shipping.
The trial plan reference, product lots, laboratory and custodians are filled in, and the criteria freeze date is earlier than the first sample.
Every planned sample, control, baseline, retained split and blank has a unique ID and a role in the register.
Each trial sample has a paired control drawn on the same day, from the same point type and by the same method.
Each sample has a holding time from the test method or laboratory, and a latest analysis start.
Containers, labels, seals and coolers are on site, and seal numbers are written down before use.
The transport classification has been taken from the product SDS, and the package meets the transport rules that apply.
The carrier, tracking number, required transport temperature and expected arrival are on the shipment entry.
Every handover line has two signatures, a date, a time, a purpose and a place.
The laboratory knows to record seal condition, container condition and arrival temperature.
The rule for a broken chain is written down before results are seen: the affected result is not interpreted, and the sample is replaced or the run is repeated.
When does a trial sample custody record not fit?
A trial sample custody record does not fit samples taken for enforcement, forensic, clinical or regulatory compliance purposes, where the custody rules come from the regulator or the court and not from a trial plan. ASTM D4840 states that "In a legal or regulatory situation custody documentation alone is not sufficient" and notes that legal counsel may be needed to judge what is sufficient (ASTM, 2018). Regulated holding times are a second limit: US Clean Water Act testing uses the prescribed containers, preservation and maximum holding times in 40 CFR 136.3 Table II (40 CFR 136.3, eCFR 2026), and a trial form does not replace them.
The template also fits poorly where no physical sample moves, such as a trial read only from in-line instruments, and it is more than a bench trial inside one laboratory needs, where the laboratory's own sample system already holds the identity and storage record. Check the sampling method before using the form for petroleum products: ASTM D4057-22, the manual sampling practice for petroleum and petroleum products, does not cover electrical insulating oils and hydraulic fluids (ASTM, 2022). A paper or electronic version works equally well, as long as the same fields are kept. Lubinpla's trial preparation fixes each sample's holding time and each handover's transport classification and receipt record before the trial plan is issued for your review, and it marks a value it could not find in your records as unconfirmed instead of filling it in.