ON-SITE LOG Collector name * (The collector filling this out) Collection Date * MM DD YYYY Company Name * DOT OR NON-DOT? * NON-DOT DOT (Department of Transportation) Both Location * (City, State) Time you began: * Hour Minute Second AM PM Time collection ended * Hour Minute Second AM PM Email for results * Select what applies * NEW LOG CONTINUOUS UPDATED LOG Original Amount of Testees: Total collected today: * Total collected all together (specifically for continuous log) Credits * (If applicable) Lab Total sent to the lab * SPECIMEN(S) SENT TO LAB (Include name of each donor sample that went to lab) One donor name & specimen # per line Lab cups remaining Rapid cups remaining SPECIMEN TRACKING NUMBER Additional collectors/ information (If applicable) Thank you!