Get Laboratory Personnel Report (clia) - Colorado.gov

Filling out the Laboratory Personnel Report (CLIA) is essential for documenting the qualifications of technical personnel within your laboratory. This guide provides clear and supportive step-by-step instructions to help you complete the form online efficiently.

Follow the steps to complete the LABORATORY PERSONNEL REPORT (CLIA) effectively.

1. Press the ‘Get Form’ button to access the form and open it in the online editor.
2. In the first section, enter the laboratory name, followed by the CLIA identification number, and the laboratory address, including street number, city, and state.
3. Provide the laboratory's telephone number, including the area code.
4. List all technical personnel employed by the laboratory in the designated table, including their last name, first name, and middle initial.
5. For each personnel member, check the appropriate column to denote the position they hold (e.g., Director, Clinical Consultant, Technical Consultant). Specify whether their shift is (1) day, (2) evening, or (3) night.
6. Indicate the highest level of testing for which each personnel member is qualified by using (M) for moderate complexity or (H) for high complexity.
7. Indicate whether each position held is full-time (F) or part-time (P).
8. If you need more space to list additional technical personnel, check the box provided and attach any necessary continuation sheets.
9. Before signing, ensure all information is correct. The laboratory director must sign off on the report, certifying that all individuals listed qualify for their respective positions under the relevant regulations.
10. Finally, save your changes, download, print, or share the completed form as needed.

Complete your documents online today to ensure compliance and proper documentation for your laboratory personnel.