Laboratory sample delivery note template
Laboratory sample delivery note template for couriers: sample IDs, collection times, temperature at pick-up and handover, seal numbers and reception signature.
Templates by industry
- Drinking water samples, 500 ml sterile bottles, chilled
- Soil samples, 250 g jars
- Surface swabs in transport medium, tubes
- Cool box with ice packs, returned empty
Preparation guide
Example workflow
Pick and pack
Example: count "Drinking water samples, 500 ml sterile bottles, chilled" and the other lines against the order, and note anything that ships later.
Ship with the note
Put the note in or on the shipment with the tracking number and package count, and check "Cool box with ice packs, returned empty" is listed.
Get it signed
Ask the recipient to sign and date the received-by line, and keep the signed copy as proof of delivery.
A laboratory can only test what arrives as it was taken. Many tests have a limit on the time between collection and analysis, and a sample that warmed up in a van may be refused. The courier’s note is therefore the record of the sample’s journey: which containers, collected when, held at what temperature and handed to whom. This template lists the containers by type, with room for the times and readings that a laboratory’s reception checks first.
Fields to prepare
- Deliverables and line items
- Drinking water samples, 500 ml sterile bottles, chilled, Soil samples, 250 g jars, Surface swabs in transport medium, tubes, Cool box with ice packs, returned empty: record the quantity actually shipped for each line; prices stay off the note.
- Drinking water samples, 500 ml sterile bottles, chilled
- Record the collection time and the temperature at pick-up for each bottle; the laboratory will tell you how many hours it allows between sampling and analysis.
- Soil samples, 250 g jars
- Soil jars are labelled by site and depth; copy that label exactly, since the lab reports against it, and keep the jars upright and apart from the water bottles.
- Surface swabs in transport medium, tubes
- Count swabs against the sampling plan the customer sent, and write whether a tube was opened or damaged; a tube with a loose cap is a lost sample.
- Cool box with ice packs, returned empty
- Write the box number and note that it returns empty; labs want the box back, and the ice-pack count shows whether the load was kept cold on the way.
- Order and delivery
- Quote the order or invoice number the delivery belongs to, the delivery date and the address the goods go to.
- Shipment
- Give the number of packages, the carrier or shipping method and the tracking number.
- Scope to agree
- Record the sample IDs as written on the containers, the time each was collected, the temperature of the box at pick-up and at handover, and any seal numbers.
Before sending
- Was “Drinking water samples, 500 ml sterile bottles, chilled” counted when it was packed, and does the count match the order?
- If “Soil samples, 250 g jars” ships short, does the note say how many follow and when?
- Will the receiver be able to check “Surface swabs in transport medium, tubes” against this note on arrival?
Show 4 more
- Was “Cool box with ice packs, returned empty” counted when it was packed, and does the count match the order?
- Check the delivery address, the number of packages and the order or invoice number the delivery belongs to.
- Count each line against the order, and list anything that ships later rather than leaving it off.
- Leave prices off the note unless the customer asks for them; they belong on the invoice.
Worked example with sample figures
The quantities below are invented to show how the template is filled in: 4 lines, counted in units, with no prices.
| Item | Quantity |
|---|---|
| Drinking water samples, 500 ml sterile bottles, chilled | 12 |
| Soil samples, 250 g jars | 8 |
| Surface swabs in transport medium, tubes | 20 |
| Cool box with ice packs, returned empty | 2 |
| Total | 42 |
42 units in 4 lines.
- The goods ship against sales order SO-LAB-7710.
- Packages: 2.
What the document must show
These details make a delivery note easier to approve and to file.
- Your company name and address
- The customer's name and delivery address
- Note number and delivery date
- The order or invoice it belongs to
- Each item with the quantity delivered
- Packages and carrier or tracking number
- A line for the recipient's signature and date
This document prints quantities without prices, so no tax appears on it unless you switch its line columns to prices and totals.
Frequently asked questions
What should the courier do if the box is warmer than the limit at pick-up?
Write the reading on the note and tell the sender before leaving. The laboratory decides whether to accept or reject it, and the note shows the temperature was recorded, not discovered at reception.
Who signs for the samples at the laboratory?
The person at sample reception who checks the containers and the temperature, with the time. Ask for a printed name beside the signature, and keep a copy, since it ends the courier’s responsibility for the load.
Does this delivery note show prices or tax?
This document prints quantities without prices, so no tax appears on it unless you switch its line columns to prices and totals. The worked example above counts 42 units and nothing else.
Is this template free?
Yes. You can fill in this template and print it or save it as a PDF without an account, and there is no payment step and no watermark on the document. Saving it to your account and downloading Excel or Word files need a free account.
Can I change the layout and colour?
Yes. The editor offers other layouts and a document colour for the printed page. Changing them moves no figure: the lines and totals stay as they are, and the PDF, Word and Excel files follow the layout you pick.
Read next
Reading for the Laboratory sample delivery note template: Quote, proforma, invoice, receipt, credit note: which to use and How to write an invoice: a step-by-step example. The order this delivery answers is written on the Purchase order template.