Fillable Request for Laboratory Examination

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Request for Laboratory Examination

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Version: 2.1 Issuing Authority: Quality Assurance Manager
Document ID: Request for Laboratory
Examination Revision Date: September 23, 2019
Page of
Hennepin County Sheriff’s Office
Forensic Science Laboratory
531 Park Avenue South Minneapolis, Minnesota 55415 612-596-7010
Request for Laboratory Examination
Submitting
Agency:
Agency
Case #:
Offense
Type:
Offense
Date:
Offense Address: Offense City:
Investigating Officer:
Investigating Officer
E-Mail Address:
Investigating Officer Direct Telephone #:
LIMS Entry By:
Laboratory
Case #:
Other Evidence related to this case has previously been submitted to the laboratory. Existing Laboratory Case #:
List all Principals involved in the incident below.
Last: First: Middle:
Suspect
Other
Sex:
SID #:
FBI #:
DOB:
Victim Alias
Last: First: Middle:
Suspect Other
Sex:
SID #:
FBI #:
DOB:
Victim
Alias
Last: First: Middle:
Suspect
Other
Sex:
SID #: FBI #:
DOB:
Victim Alias
Last: First: Middle:
Suspect
Other
Sex:
SID #:
FBI #:
DOB:
Victim
Alias
Last: First: Middle:
Suspect
Other
Sex:
SID #:
FBI #:
DOB:
Victim
Alias
Business Name (if applicable):
Rush Case Request: All rush requests require Crime Laboratory Supervisor approval. Please contact Jim Liberty, Melissa Hummel or Scott Giles
for rush approvals. The laboratory will accommodate rush requests only under certain circumstances i.e. pending court date, exigent
circumstances. Please attach a copy of written approval to this form.
Approval
The Request for Laboratory Examination form must be completed for all evidence submissions. This form is designed to assist the laboratory in expediting the
examination and testing of the submitted evidence by ensuring that all of the necessary information regarding the case has been provided.
The form should be filled out as completely as possible (Please print legibly). Incorrect or incomplete information on the form may delay the processing of evidence.
Relevant Case Information and/or Special Instructions:
Version: 2.1 Issuing Authority: Quality Assurance Manager Document ID: Request for Laboratory Examination
Revision Date: September 23, 2019
Page of
Lab
Item #
Agency
Item #
Description of Evidence
(Please associate evidence with appropriate individuals)
Examination(s)
R
equested
L=Latents
B=Biology
F=Firearms
S=Storage
D=Destruction
If you are submitting more than fourteen (14) items, please list additional items on the Request for Laboratory Examination (Supplement) Form.
The following measures will help expedite the examination and testing of the evidence you have submitted:
• DNA cases – if available, submit known DNA samples (buccal swabs) for all involved persons
• Fingerprint cases – If available, submit the SID # and FBI #, as well as known fingerprint samples (fingerprint and palm cards) for all involved persons
•
All cases – Submit a copy of the agency offense report
The completed form serves as a proposed agreement for services between the submitting agency and the laboratory. The laboratory reserves the right to select the
most appropriate methods for the examination and testing of the items submitted, including which items to test. Additional information regarding the laboratory’s
evidence submission, examination, and testing procedures if available upon request.
Evidence Submitted By (Print Name – First & Last)
Signature
Time Received
Evidence Received By (Print Name – First & Last)
Signature
Date Received
Submitting Agency Case #:
Laboratory Case #:
Compliance with MN Statute 299C.106 'Sexual Assault Examination Kit Handling':
When routing a sexual assault examination kit
to storage, please indicate the reason testing is not requested:
previously tested
restricted kit
other:
The following measures will help expedite the examination and testing of the evidence you have submitted:
• DNA cases – if available, submit known DNA samples (buccal swabs) for all involved persons
• Fingerprint cases – If available, submit the SID # and FBI #, as well as known fingerprint samples (fingerprint and palm cards) for all involved persons
• All cases – Submit a copy of the agency offense report
Evidence Intake Appointment Notes:
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Request for Laboratory Examination

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Completed 11 February 2021

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