DATE
1. DOPING CONTROL SESSION
DD
MM
YYYY
2. SAMPLE ID
3.TRANSPORTATION AND STORAGE
4. DCO TRANSFER TO LABORATORY, COURIER OR OTHER
IF TRANSFERRED TO LABORATORY
IF TRANSFERRED TO COURIER
IF TRANSFERRED TO OTHER
A/B
A/B
A/B
A/B
A/B
A/B
A/B
A/B
A/B
A/B
A/B
A/B
A/B
A/B
A/B
FROM
(LOCATION)
DCO
SIGNATURE
TO
(LOCATION)
AUTHORISED COLLECTION AGENCY
CHAIN OF CUSTODY FORM
TEST AUTHORISED BY
TIME SESSION
COMPLETED
DATE
DD
MM
YYYY
TIME
DCO
SIGNATURE
ARRIVAL
DATE
DD
MM
YYYY
DEPARTURE
DATE
ARRIVAL
TIME
DEPARTURE
TIME
DD
MM
YYYY
TO
(LOCATION)
DCO
SIGNATURE
DCO
SIGNATURE
ARRIVAL
DATE
DD
MM
YYYY
DEPARTURE
DATE
ARRIVAL
TIME
DEPARTURE
TIME
DD
MM
YYYY
ARRIVAL
DATE
DD
MM
YYYY
DEPARTURE
DATE
ARRIVAL
TIME
DEPARTURE
TIME
DD
MM
YYYY
DCO
SIGNATURE
DCO
SIGNATURE
ARRIVAL
DATE
DD
MM
YYYY
DEPARTURE
DATE
ARRIVAL
TIME
DATE
DD
MM
YYYY
DROP-OFF
TIME
DEPARTURE
TIME
DD
MM
YYYY
ARRIVAL
DATE
DD
MM
YYYY
DEPARTURE
DATE
ARRIVAL
TIME
DEPARTURE
TIME
DD
MM
YYYY
DCO
NAME
ORIGINAL - ADO - WHITE COPY 1 - AUTHORISED COLLECTION AGENCY - GREEN
COPY 2 - LABORATORY - YELLOW VERSION 2: 04-2004 (WADA/AMA)
TEST
LOCATION
CITY
STATE
COUNTRY
NUMBER OF
SAMPLES
URINE
BLOOD
SPORT
OUT OF
IN
COMPETITION
COMPETITION
DCO NAME
TEST
MISSION
CODE
LAB REP.
NAME
LAB REP.
POSITION
LAB REP.
SIGNATURE
COMPANY
NAME
WAYBILL
NUMBER
COURIER
SIGNATURE
OTHER
NAME
OTHER
POSITION
OTHER
SIGNATURE
TO
(LOCATION)
TO
(LOCATION)
TO
(LOCATION)
CoCForm_Ext-Orgs.qxd 14/04/2004 5:51 PM Page 1