FTCOE White Box Study

Agency Name*

Please enter your agency/organization name below.

Note: You will be asked to enter this information again with each of your sample submissions for tracking purposes.

Sample Specific Questions

For each sample analyzed, you will need to provide the following:

Sample ID Number
Report File Upload
Other Non-Reported Findings
Quality Assurance Measures Used
Sample Components Identified

Sample ID*

Please enter the sample identification number you are reporting on in the space below.

File Upload*

Please provide a typical report for this sample as you would for routine casework. Upload the file here.

Drag and drop files here or

Additional Information #1*

What else did you find that you wouldn’t report due to agency policies or other reasons? For anything else found but not reported, what are the reasons it is not included in the report?

Additional Information #2*

Are there any other properties of what is reported that are not included in the report, such as a specific isomer determination?

Quality Assurance*

Which quality assurance measures were used? Select all that apply.

Did not use quality assurance measures

The analysis of two or more separate portions

Sample identification procedures such as bar-coding and witness checks

Good laboratory practices (For example, positive and negative controls, one sample opened at a time, procedural blanks).

Other - specify below.

Other Quality Assurance

If you selected Other above, please specify.

Components Identified in Sample

For each component identified in the sample, you will need to provide the following:

Actual Component Name Reported
Tests Performed
If an In-House Reference Material was Used
If an External Library was Used

Please fill in the requested component identification information in the spaces provided below.

Note: you may not need to use all the spaces provided depending on the number of components identified in your sample.

Component 1

Please complete the following responses for the component identified.

Note: If you do not need this space, you can leave it blank or type N/A for not applicable.

C1: What component was identified?

C1: Tests Performed

Please list all tests performed in the analysis of this sample component (e.g., identify specific color tests by name, microcrystalline tests by name, instrumentation used – IR, GC-MS, immunoassay).

C1: Objective Evidence

What is the objective evidence you provided to support your identification?

Library match to an external library (e.g. SWGDRUG, NIST, Cayman)

In-house tested reference material

Both of the above

C1: If an external library was used

If you used an external library, please identify which external library was used to confirm the identification.

Component 2

Please complete the following responses for the component identified.

Note: If you do not need this space, you can leave it blank or type N/A for not applicable.

C2: What component was identified?

C2: Tests Performed

Please list all tests performed in the analysis of this sample component (e.g., identify specific color tests by name, microcrystalline tests by name, instrumentation used – IR, GC-MS, immunoassay).

C2: Objective Evidence

What is the objective evidence you provided to support your identification?

Library match to an external library (e.g. SWGDRUG, NIST, Cayman)

In-house tested reference material

Both of the above

C2: If an external library was used

If you used an external library, please identify which external library was used to confirm the identification.

Component 3

Please complete the following responses for the component identified.

Note: If you do not need this space, you can leave it blank or type N/A for not applicable.

C3: What component was identified?

C3: Tests Performed

Please list all tests performed in the analysis of this sample component (e.g., identify specific color tests by name, microcrystalline tests by name, instrumentation used – IR, GC-MS, immunoassay).

C3: Objective Evidence

What is the objective evidence you provided to support your identification?

Library match to an external library (e.g. SWGDRUG, NIST, Cayman)

In-house tested reference material

Both of the above

C3: If an external library was used

If you used an external library, please identify which external library was used to confirm the identification.

Component 4

Please complete the following responses for the component identified.

Note: If you do not need this space, you can leave it blank or type N/A for not applicable.

C4: What component was identified?

C4: Tests Performed

Please list all tests performed in the analysis of this sample component (e.g., identify specific color tests by name, microcrystalline tests by name, instrumentation used – IR, GC-MS, immunoassay).

C4: Objective Evidence

What is the objective evidence you provided to support your identification?

Library match to an external library (e.g. SWGDRUG, NIST, Cayman)

In-house tested reference material

Both of the above

C4: If an external library was used

If you used an external library, please identify which external library was used to confirm the identification.

Component 5

Please complete the following responses for the component identified.

Note: If you do not need this space, you can leave it blank or type N/A for not applicable.

C5: What component was identified?

C5: Tests Performed

Please list all tests performed in the analysis of this sample component (e.g., identify specific color tests by name, microcrystalline tests by name, instrumentation used – IR, GC-MS, immunoassay).

C5: Objective Evidence

What is the objective evidence you provided to support your identification?

Library match to an external library (e.g. SWGDRUG, NIST, Cayman)

In-house tested reference material

Both of the above

C5: If an external library was used

If you used an external library, please identify which external library was used to confirm the identification.

Component 6

Please complete the following responses for the component identified.

Note: If you do not need this space, you can leave it blank or type N/A for not applicable.

C6: What component was identified?

C6: Tests Performed

Please list all tests performed in the analysis of this sample component (e.g., identify specific color tests by name, microcrystalline tests by name, instrumentation used – IR, GC-MS, immunoassay).

C6: Objective Evidence

What is the objective evidence you provided to support your identification?

Library match to an external library (e.g. SWGDRUG, NIST, Cayman)

In-house tested reference material

Both of the above

C6: If an external library was used

If you used an external library, please identify which external library was used to confirm the identification.

Comments

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Please note once you press submit, the form will reload to allow you to complete the form for the next sample submission.

You do not have to submit all 8 sample forms at one time but make sure to save a copy of your responses to keep track of which samples you have already submitted.

Questions

If you have any comments, questions, or concerns, please type them below or email Megan Grabenauer at mgrabenauer@rti.org.

Send me a copy of my responses