We’re refreshing!

Come experience the new website and submit your feedback. The current site will temporarily
remain available as we make the final adjustments to the new online experience.

Click here to check it out. ►
1 888 2 DONATE(1 888 236-6283)
Find a Clinic:  search Search this site:  search
Ready, Set...Give!
Home > Can I donate? > Can I donate?
Facebook youTube Twitter flickr
Why Should I Donate?
Who Needs Blood?
Can I donate?
Basic Eligibility
Donor Questionnaire
Malaria policy
Donation Date Calculator
American Sign Language
What Can I Donate?
Types of Donations
Plasma & Platelets
Stem Cells
Financial Gifts
Blood for Research
How Can I Get Involved?
In My Community
Send an e-card
Public Involvement
Partners for Life
What's Your Type
Sign Up to Learn More
Young Blood For Life
Assignment Saving Lives
National Blood Donor Week
What Should I Know?
Pandemic Preparedness
Safety and Testing
Research & Development
West Nile Virus (WNV)
Transfusion Related Acute Lung Injury (TRALI)
vCJD Travel Deferral
Become a Volunteer
New Donor Form
Change Your Address
Join OneMatch
Become a Partner for Life Organization
Become a Partner for Life Member
Join Ready, Set... Give!
Donor Experience Survey
Customer Service
Circular of Information
Customer Letters
Plasma Protein Products
Hospital Customer Forms
Resource Library
OneMatch Documents
Adverse Events
Diagnostic Services

Donor Questionnaire

What is the Record of Donation?

The Record of Donation is a form that captures all relevant information about you and your donation, and follows you from the registration process, through screening to giving blood. It includes a confidential questionnaire that helps determine if you are eligible to give blood.

After donation, it then travels with the unit of blood and sample through testing, processing and final use.

What You Must Know
Before filling out the donor questionnaire we ask you to read the What You Must Know to Give Blood, or the What You Must Know to Give Plasma or Platelets brochure. The brochure information will help you understand what to expect during your donation and includes some details on
post-donation care. You should also read the What Happens to Your Donation brochure to learn how your blood may be used after donation.
Record of Donation form
Record of Donation form

Completing Your Questionnaire

Help us make the most of your time and donation!

When you come in to donate blood, be sure to complete your Record of Donation by shading in the boxes on the form for questions one through 13.

Shading instead of ticking the boxes has shown to reduce incomplete questionnaires. For safety reasons, incomplete questionnaires may result in a donation not being used.

Thank you for your cooperation!
Record of Donation - shading poster

Have you wondered why we ask all these questions Every Time ?
Click on the poster below to find out.

Wonder Why? poster

Impact on Your Eligibility

An affirmative response to any of the Record of Donation questions does not necessarily mean that you are ineligible to donate. Once you have responded in writing to questions one through 13, a trained health professional will determine your eligibility during a confidential one-on-one interview with you at the blood donor clinic.

Information Recorded on the Record of Donation

  • Your donor identification and address

  • Your blood type, preferred language, and number of previous donations

  • Results of physical tests including hemoglobin, blood pressure, and temperature

  • Indication of how the unit will be processed

  • Indications of which employees served you

  • Your answers to questions on health and certain high-risk activities

  • Comments by screening employee

  • Confidential Unit Exclusion (CUE) label

  • Deferral codes, if applicable

  • Relevant details of the venepuncture and bleed time

  • Unit labelling information

  • Your signature, confirming your informed consent to use the blood collected and that you have answered all questions truthfully.

For more information about the Record of Donation, please speak to a nurse at your local blood donor clinic, or call 1 888 2 DONATE
(1 888 236-6283) and ask to speak with a member of our medical staff.

/\ Top

Top of the page Privacy and Access to Information | Terms of Use | Copyright © 1998-2015 Canadian Blood Services. All rights reserved.