Citations checked against 42 CFR Part 493 on 11 November 2026Independent publisher. Not affiliated with CMS, CDC or any accreditation organization.
CLIA Templates

Kits / Waived Testing

WT-01 to WT-06

CLIA Waived Testing Kit

A waived site has one central duty under CLIA: follow the manufacturer's instructions. Most problems at waived sites come from a procedure that drifted away from the current package insert, or from logs nobody kept.

The procedure template is laid out in the same order as a package insert, so updating it when the insert changes takes a few minutes. The logs cover what the insert asks you to record.

Written for: Physician offices, clinics, pharmacies and other sites testing under a Certificate of Waiver.

First page of WT-01 Waived Test Procedure Template, showing the document header, control block and the start of the form
WT-01 Waived Test Procedure Template, first page, before personalization. Bracketed fields fill in from the Personalize tool or by hand.

Look inside

What happens after you buy

  1. 1
    Pay securelyCheckout is run by Lemon Squeezy, which handles payment and any sales tax. Your receipt arrives by email straight away.
  2. 2
    DownloadThe receipt links to a zip file with every document in Word or Excel, plus a fillable PDF of each one. Open the Start Here guide first.
  3. 3
    Make it yoursOptional: drop the zip into the Personalize tool to add your name, CLIA number and logo to every file.
  4. 4
    Review and signYour laboratory director reviews, adapts and approves each document before use.
  5. 5
    Stay currentWhen we revise a file in the next 12 months, the updated version is available from your original order.

What is in the kit

Doc no.DocumentFormat
WT-01Waived Test Procedure Template
Intended use, specimen, storage, quality control, test steps, reading results and limitations, each tied to the package insert section.
Word + PDF
WT-02Training and Competency Checklist
Initial training sign-off and a periodic observation checklist for each person and test.
Word + PDF
WT-03Quality Control Log
Kit lot, control lot, expected and observed results, and action taken.
Excel + PDF
WT-04Temperature Log
Room and refrigerator readings against the storage range in the insert.
Excel + PDF
WT-05Kit and Reagent Lot Log
Date received, date opened, expiration and the insert revision in use.
Excel + PDF
WT-06Certificate and Test Menu Record
CLIA number, certificate expiration, director, and the waived tests the site performs.
Word + PDF

Regulation behind each document

The middle column is our plain-language summary. Read the regulation itself before you rely on it.

CitationWhat it asks forAddressed in
42 CFR 493.15(e)Laboratories performing only waived tests follow the manufacturer's instructions for each test and meet the certificate requirements in Subpart B.WT-01
42 CFR Part 493, Subpart BCertificate of Waiver application, renewal and the duty to permit inspections.WT-06

What the kit does not do

  • CLIA does not require competency assessment for waived testing. WT-02 is included because CMS describes it as good laboratory practice, and some states and accreditation organizations expect it.
  • The template does not replace the package insert. Keep the current insert with the procedure.

Your director stays in control

These are templates, written so your laboratory director can review, adapt and approve each one quickly. Nothing is used until they sign it.

CLIA is a federal minimum. Your state, and your accreditation organization if you have one, may require more. We do not promise a survey outcome, and we do not give regulatory or legal advice. Read the full terms.