InfoCard #: STCL-FORM-073 Rev. 01 Effective Date: 01 Nov 2018

STEM CELLLABORATORY (STCL)

DOCUMENT NUMBER: STCL-FORM-073

DOCUMENT TITLE:

C02 Incubator Plate Inspection Log

DOCUMENT NOTES:

Document Information

Revision: 01 Vault: STCL-Form-rel

Status: Release Document Type: STCL FORM

Date Information

Creation Date: 18 Oct 2018 Release Date: 01 Nov 2018

Effective Date: 01 Nov 2018 Expiration Date:

Control Information

Author: WATE02 Owner: WATE02

Previous Number: None Change Number: STCL-CCR-433

CONFIDENTIAL - Printed by: ACM93 on 01 Nov 2018 08:14:14 am

InfoCard #: STCL-FORM-073 Rev. 01 Effective Date: 01 Nov 2018

Stem Cell Laboratory

Equipment:SN:Location:MonthA^ear:

STCL-FORM-073C02 INCUBATOR PLATE INSPECTION LOG

. = OK or function performed NP = Not Performed Record problem and corrective action on reverse side

DAILY:

ALL plates storedin the TOPCHAMBERwere inspectedfor contaminationor film

Initials

DAILY:

ALL plates storedin the BOTTOMCHAMBER

were inspectedfor contaminationor film

Initials

(S m -r IT- ^0 r~ ao 0\0 r^ 1^ -r IT. ^0 r~ ao 0^ 0

(S N s a s IT.N ^ K so

d s ? m

Weekly Review: (Initials/Date)Wkl

Monthly Review (Date/Initial):

Wk2 Wk3 Wk4 Wk5

NOTE: Each CPU assay plate, stored in the CO; Incubators, was inspected to ensure there was NO visible contamination or film on the bottom of the plates. If a problem is noted, please notifysenior staff immediately and record information on the troiibleshooting log so investigation and/or corrective action can be initiated ASAP to minimize the number of samples that are impacted."STCL-FORM-073 C02 Incubator Plate Inspection LogStem Cell Laboratory, DUMCDurham, NC

CONFIDENTIAL - Printed by: ACM93 on 01 Nov 2018 08:14:14 am Page 1 of 1

InfoCard #: STCL-FORM-073 Rev. 01 Effective Date: 01 Nov 2018

Signature Manifest

Document Number: STCL-FORM-073

Title: C02 Incubator Plate Inspection Log

Revision: 01

All dates and times are in Eastern Time.

STCL-FORM-073 C02 Incubator Plate Inspection Log

Author

Name/Signature Title Date Meaning/ReasonBarbara Waters-Pick(WATE02)

Manager

18 Oct 2018, 06:36:18 PM Approved

Name/Signature

Barbara Waters-Pick(WATE02)

Medical Director

Title Date Meaning/Reason

18 Oct 2018, 06:36:31 PM Approved

[ Name/Si^gnatureJoanne Kurtzberg(KURTZ001)

Title I Date ! Meaning/Reason

18 Oct 2018, 09:22:08 PM Approved

Quality

Name/Signature

Richard Bryant (RB232)

Document Release

I Name/Signature

Title

Title

Date

19 Oct 2018, 07:45:58 AM

Date

Meaning/Reason

Approved

Meaning/Reason

Sandy Mulligan (MULL1026) 23 Oct 2018, 05:16:07 PM Approved

CONFIDENTIAL - Printed by: ACM93 on 01 Nov 2018 08:14:14 am