STATE MPI PROGRAM: 

LABORATORY NAME: 

LABORATORY ADDRESS: 

CITY: STATE: ZIP:

LABORATORY DIRECTOR/POINT(S) OF CONTACT: 

LABORATORY REPRESENTATIVE(S) AT REVIEW: 

REVIEWER(S): 

DATE OF REVIEW: 

This checklist is intended to help laboratories improve the quality of their testing programs with regard to meat and poultry testing samples, in order to 

ensure those laboratories are “at least equal to” the U.S. Department of Agriculture, Food Safety and Inspection Service Field Service Laboratories. 

The laboratory management should strive to ensure that policies and procedures are written and each laboratory meets the elements listed herein. All 

quality system documentation and supporting records must be available for the assessor's review. 

STATE MEAT AND POULTRY INSPECTION (MPI) PROGRAM 

LABORATORY QUALITY MANAGEMENT SYSTEM CHECKLIST

FOR USE AS A SELF ASSESSMENT TOOL, PARTICIPATING LABORATORY PERSONNEL ARE TO COMPLETE AND SUBMIT TO FSIS AS 

PART OF THEIR ANNUAL SUBMISSION PACKAGE.

Instead of completing its own testing, does the State have a partnership with another State, 

private laboratory or federal laboratory meeting all MPI requirements to maintain some or all 

testing capability for MPI purposes? If YES, describe the relationship below:

 Yes No N/A

1.

US Department of Agriculture 

Food Safety Inspection Service 

Office of Public Health Safety

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it 

displays a valid OMB control number. The valid OMB control number for this information collection is 0583-0170. The time required to complete this information collection 

is estimated to average 113 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data 

needed, and completing and reviewing the collection of information.

Page 1 of 12
STATE MEAT AND POULTRY INSPECTION (MPI) PROGRAM 

LABORATORY QUALITY MANAGEMENT SYSTEM CHECKLIST

Page 2 of 12

NOTE: For example, any work including confirmatiotttne or serology/serotyping that is 

performed offsite or by another lab is considered subcontracted and must be listed. 

Detailed written documentation, e.g., MOU or contract, between laboratories to 

perform the work must be provided. Each laboratory shall submit the completed 

checklist and requested information.

3. For laboratories performing analysis for MPI purposes:

a) Is the laboratory accredited to ISO/IEC 17025?

b) Are all methods used by the laboratory in support of the MPI program included in the 

 scope of accreditation? 

SKIP to page 9, question 38, if the answers to 3a and 3b are yes.

NOTE: All laboratories must still comply with the listed QA checklist requirements.

 Yes No N/A

 Yes No N/A

 Yes No N/A

2. Does the laboratory subcontract any MPI related analyses with one or more private 

 or non CIS/MPI state laboratories? If YES provide the name of each facility with 

 physical address, phone number and main point(s) of contact. Also, list the analyses 

 or tests that each subcontracted laboratory performs. 

FSIS FORM 5720-14 (04/04/2017)
STATE MEAT AND POULTRY INSPECTION (MPI) PROGRAM 

LABORATORY QUALITY MANAGEMENT SYSTEM CHECKLIST

Page 3 of 12

A. MANAGEMENT GUIDELINES

6. Does the laboratory follow a written policy that identifies the responsibilities, 

 authority and interrelationships of all key personnel who may influence or be 

 involved in the testing activities of the laboratory in order to prevent any 

 potential conflicts of interest? 

7. Does the laboratory have managerial and technical personnel with both the 

 authority and the resources needed to carry out their duties?

10. Does the laboratory follow written procedures to control all documents that 

 form part of its quality system, e.g., regulations, methods, software, 

 instructions, standards, and manuals, including procedures for:

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

a) Ensuring prior approval of all documents?

b) Ensuring periodic review of all documents?

 c) Ensuring that any changes to documents are approved?

d) Ensuring that only the current revision is being used?

e) Ensuring suitable markings of retained obsolete documents? Yes No N/A

4. Does the laboratory follow a written quality management system to meet the 

 requirements of FSIS and the regulatory authorities of the State? 

9. Does the laboratory follow written procedures to ensure that all of its 

 personnel, including management, are free from any undue internal and 

 external pressures and influences that may adversely affect the quality of their 

 work? 

8. Does the laboratory have managerial and technical personnel with both the 

 authority and resources to identify departures from their quality system and 

 to initiate actions to prevent or minimize any such departures? 

5. Does the laboratory quality system cover all work carried out at sites 

 away from its permanent facilities and/or in associated temporary or mobile 

 facilities, as well as all work carried out in the laboratory's permanent facilities?

FSIS FORM 5720-14 (04/04/2017)
STATE MEAT AND POULTRY INSPECTION (MPI) PROGRAM 

LABORATORY QUALITY MANAGEMENT SYSTEM CHECKLIST

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

Page 4 of 12

a) That identify the responsibilities and authorities for the 

 management of nonconforming work? 

b) That identify the actions to be taken when 

nonconforming work is identified (including the halting

of work and withholding of test reports, as necessary)?

d) That include the monitoring of results to ensure that the 

 corrective actions taken have been effective? 

e) That identify needed improvements and potential sources of 

 nonconformance, and do they take preventive action to reduce 

 the likelihood of the occurrence of such non-conformances?

16. Does the laboratory follow written procedures to ensure that all observations, 

 data, and calculations are recorded at the time they are made 

 and are identifiable to a specific task?

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

12. Does the laboratory follow written policies and procedures detailing the 

 acceptable handling of nonconforming work or any departures from the 

 policies and procedures in either their quality system or technical operations:

14. Are all records legible, held secure and in confidence for a defined period 

 and retained in a suitable environment to prevent alteration, damage, 

 deterioration, and/or loss? 

 

 

 

13. Does the laboratory follow a written system and have supporting records 

 that ensures test samples are traceable to equipment, critical supplies, and 

 personnel from receipt through disposal of sample reserves? 

 

11. Does the laboratory verify that supplies comply with the

 standard specifications or requirements defined in the methods concerned?

15. Does the laboratory follow written procedures to ensure that any mistakes 

 occurring in records are not deleted, or otherwise made illegible, but 

 instead are crossed out and the correction entered alongside, with the 

 person making the correction, signing or initialing and dating the change?

c) That require corrective actions be taken immediately, Yes No N/A

 together with any decision about the acceptability of the 

 nonconforming work, including notifying the client (if necessary)?

FSIS FORM 5720-14 (04/04/2017)
STATE MEAT AND POULTRY INSPECTION (MPI) PROGRAM 

LABORATORY QUALITY MANAGEMENT SYSTEM CHECKLIST

B. TECHNICAL GUIDELINES 

Page 5 of 12

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

18. Does the laboratory follow written policies and procedures for 

 identifying training needs and providing training of personnel? 

19. Are training/education/experience records for all technical personnel 

 available? 

20. Does the laboratory follow written policies and procedures to ensure that the 

 environmental conditions do not invalidate the test results or otherwise adversely 

 affect the required quality of any measurement or test, e.g., maintaining 

 separation between areas with incompatible activities, ensuring good 

 housekeeping in the lab, conductivity/resistivity testing of DI water, and where 

 applicable, monitoring environmental conditions such as temperature, humidity, 

 biological sterility, and dust)?

21. Does the laboratory follow written policies and procedures to ensure that only 

 test methods and procedures that are fit for purpose are used and 

 justified, authorized, validated, and documented? 

23. Does the laboratory follow written procedures to ensure that all calculations and 

 data transfers are subject to appropriate checks in a systematic manner?

24. Does the laboratory follow written procedures to ensure that any computer 

 software developed by the user is validated before use?

25. Does the laboratory follow written policies and procedures to ensure that 

 all equipment of and software used for testing, calibration, and sampling 

 is uniquely identified, capable achieving the accuracy required, and, prior 

 to being placed into service, complies with the specifications relevant to 

 the tests and/or calibrations concerned? 

 

 22. Does the laboratory follow written policies and procedures to validate/verify 

 the performance of authorized methods as written, and to ensure confirmation 

 of this fact prior to using the methods? 

17. Do the observations, data and calculations contain sufficient information to 

 help facilitate identification of factors that may either affect the uncertainty 

 and/or enable the test to be repeated under conditions as near to the original 

 as possible? 

 Yes No N/A

FSIS FORM 5720-14 (04/04/2017)
STATE MEAT AND POULTRY INSPECTION (MPI) PROGRAM 

LABORATORY QUALITY MANAGEMENT SYSTEM CHECKLIST

Page 6 of 12

a) Calibrations performed prior to being placed in service?

c) Are certified reference cultures (CRC) traceable to a nationally or 

 internationally recognized type culture collection, e.g., ATCC, or reference 

 cultures (RC) from laboratory sources identified for key biochemical and 

 physiological characteristic relative to standard reference sources used? 

 (Microbiology) 

d) Are these CRCs and RCs transferred no more than 5 times to maintain 

 their biochemical reaction and physiological characteristic integrity before 

 being replaced or re-identified for key biochemical and physiological 

 characteristics using nationally or internationally recognized reference 

 sources? (Microbiology) 

e) Are reagents, standards, and reference materials in each method traceable?

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

28. Does the laboratory follow written policies and procedures for the calibration of its 

 equipment and the use of reference standards and materials, and do they include at 

 least the following: 

 Yes No N/A

 Yes No N/A

 Yes No N/A

27. Are records for this equipment and software maintained and do they include at least 

 the following: 

a) The identity and unique identification of the equipment and/or software? 

b) User instructions (preferably manufacturer's instructions)? 

c) Checks that the equipment complies with the required specifications?

d) Dates, results and copies of reports and certificates of all maintenance, 

 calibrations, and adjustments, including any damage, malfunction, 

 modification or repair to the equipment?

 Yes No N/A

b) Instructions for the safe handling, transport, storage and 

 use of reference standards and reference materials in order to 

 prevent contamination or deterioration and in order to protect their 

 integrity?

 Yes No N/A

 Yes No N/A

26. Does the laboratory follow written procedures to ensure the proper 

 tests and/or calibrations concerned, use and plan maintenance 

 of all equipment, and ensure that any defective equipment, e.g., 

 equipment outside specified limits, is removed from service and clearly 

 labeled as "out of service"? 

FSIS FORM 5720-14 (04/04/2017)
STATE MEAT AND POULTRY INSPECTION (MPI) PROGRAM 

LABORATORY QUALITY MANAGEMENT SYSTEMCHECKLIST 

Page 7 of 12

 Yes No N/A

 Yes No N/A

 Yes No N/A b) Replicate tests using duplicates of the same sample? 

 (Chemistry)

c) Confirmation testing by a cultural method when a screen method 

 indicates a presumptive positive? (Microbiology) Yes No N/A

c) Avoiding deterioration, loss or damage to the sample during 

 storage, handling, and preparation? 

d) Providing (where necessary) secure storage that protects the 

 condition and integrity of the samples (or portions)? 

 Yes No N/A

 Yes No N/A

e) Defined Sample Conditions (temp, storage/transit time, storage time 

 on receipt) when trans-shipping to a contract laboratory for analysis 

 completion, e.g., confirmation, serology/serotyping?

a) (If available) Regular use of certified reference materials, cultures, 

 internal quality controls using secondary reference materials, and/or 

 appropriate quality control strains accompanying the sample to 

 confirmation, e.g., for Salmonella analysis using H2S+ & H2S-

 Salmonella control strains?

b) Recording, upon receipt, sample acceptance or discard determination and, if

 applicable, abnormalities/departures from expected conditions?

30. Regarding the receipt, handling, protection, storage, retention and/or disposal of samples, 

 does the laboratory follow written procedures that include: 

 Yes No N/A

 Yes No N/A

a) Ensuring that samples and their associated records can be uniquely 

 identified and traced throughout their lives in the laboratory? 

29. For those laboratories responsible for sample collection: 

 

 Yes No N/A

 Yes No N/A

 a) Does the laboratory follow written policies and procedures for sampling, 

 based on appropriate statistical methods?

 b) Are traceability records maintained for this sampling that include 

 identification of the sample, identification of the sampler, the environmental 

 conditions, and the identification of the sampling location (where necessary)?

FSIS FORM 5720-14 (04/04/2017)

31. Does the laboratory follow written quality control procedures monitoring the 

 validity of all tests undertaken to include, but not limited to, the following:
STATE MEAT AND POULTRY INSPECTION (MPI) PROGRAM 

LABORATORY QUALITY MANAGEMENT SYSTEMCHECKLIST 

Page 8 of 12

34. Do laboratory sample records contain at least the following, to ensure traceability: 

 b) The name of the laboratory, or other unique identification or 

 description of where testing was carried out? 

 Yes No N/A

c) Identification of the method used for the testing, along with 

 any deviations from or additions to the test method? 

d) Any appropriate dates associated with the testing, e.g., 

 sample receipt date, incubation time-in and time-out dates, 

 testing date(s), etc.?

e) The name(s), title(s), and signature(s) (or other equivalent 

 identification) of person(s) approving the release of test data 

 for reporting? 

35. Does the laboratory test and record media productivity/sterility results, assign expiration 

 dates and prohibit use of expired media, reagents and critical supplies on customer 

 samples? 

36. Are expired media, reagents and critical supplies properly disposed of in a defined 

 time frame? 

37. Does the laboratory have plans for ISO 17025 accreditation during the next year? 

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

 Yes No N/A

 f) In records containing the results of sampling, the date/location 

 of the sampling and date results are reported as positive or 

 negative?

a) Unique identification of personnel preparing samples and 

 performing tests? 

 Yes No N/A

32. Does the laboratory:

a) Participate in inter-laboratory comparison or proficiencytesting (PT) programs where available or an intra-laboratory 

program? 

 NOTE: PT samples must be analyzed in all laboratories that 

perform any portion of the test for the MPI program in the same 

manner as MPI establishment samples are analyzed. PT 

programs shall cover the entire method. 

b) Use quality control samples with each batch run? (Microbiology 

requires positive and sterility controls.) 

 Yes No N/A 33. Does the laboratory follow written policies and procedures to 

 ensure that the results of each test or series of tests carried out by the 

 laboratory are reported accurately and in accordance with any specific 

 instructions listed in the test method or as otherwise instructed? 

 Yes No N/A

 Yes No N/A

FSIS FORM 5720-14 (04/04/2017)
STATE MEAT AND POULTRY INSPECTION (MPI) PROGRAM 

LABORATORY QUALITY MANAGEMENT SYSTEM CHECKLIST

Page 9 of 12

 Yes No N/A 38. List each method the laboratory uses in support of the FSIS MPI Program including title, 

 revision number/date, commodities described (for preparation, start up) and associated SOPs 

 for information not included in the method itself. For any method/revision and SOP not 

 previously submitted, include a copy in the submission package for review. 

FSIS FORM 5720-14 (04/04/2017)
STATE MEAT AND POULTRY INSPECTION (MPI) PROGRAM 

LABORATORY QUALITY MANAGEMENT SYSTEM CHECKLIST

Page 10 of 12

 39. Have any additional analysts been trained since the last submission?

40. List by analysis, the names of all analysts trained to perform each scope method: 

 Yes No N/A

41. List the proficiency test programs the laboratory participates in for each method/analyte including in-house prepared 

samples for analytes without external programs: 

FSIS FORM 5720-14 (04/04/2017)
Page 11 of 12

STATE MEAT AND POULTRY INSPECTION (MPI) PROGRAM 

LABORATORY QUALITY MANAGEMENT SYSTEM CHECKLIST

Comments: Attach additional page if needed. 

FSIS FORM 5720-14 (04/04/2017)
STATE MEAT AND POULTRY INSPECTION (MPI) PROGRAM 

LABORATORY QUALITY MANAGEMENT SYSTEM CHECKLIST

Page 12 of 12

Instructions for Completing the Form 

 1. Enter the information requested. Answer all questions on the checklist by selecting the appropriate response for each question. Use 

 page 9 for additional information and clarifications. Questions pertaining to services, equipment, instruments, methods or 

 procedures not used routinely by the laboratory should be marked not applicable (N/A). 

 2. The question requirements are related to the laboratory services in support of the State MPI Program only. These requirements do 

 not apply to testing performed under other programs. 

 3. Submit the completed form electronically to: 

* When submitting the form please include 

 the supported state name in the subject of the email.

FSIS FORM 5720-14 (04/04/2017)