FSIS Form 10,000-8 Pasteurized Egg Products Recognized Laboratory (Peprlab) Program Information Update Request Form

Form 10,000-8 is a U.S. Department of Agriculture - Food Safety and Inspection Service form also known as the "Pasteurized Egg Products Recognized Laboratory (peprlab) Program Information Update Request Form". The latest edition of the form was released in March 9, 2016 and is available for digital filing.

Download an up-to-date fillable Form 10,000-8 in PDF-format down below or look it up on the U.S. Department of Agriculture - Food Safety and Inspection Service Forms website.

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OMB Approval Number 0583-0082
Expires 01/31/2018
US Department of Agriculture
According to the Paperwork Reduction Act of 1995, an agency may
Food Safety Inspection Service
not conduct or sponsor, and a person is not required to respond to,
a collection of information unless it displays a valid OMB control
Pasteurized Egg Products Recognized Laboratory
number. The time required to complete this information collection is
estimated to average 30 minutes per response, including the time
(PEPRLab) Program Information Update Request Form
for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the
collection information.
The detailed information on this update is considered proprietary and will not be released. However, a list of Recognized Laboratories
complete with addresses, telephone numbers, and contact personnel is distributed.
1.
Laboratory Name:
(Official Name)
2.
Doing business as (if applicable):
Address:
ZIP
CITY:
STATE:
CODE:
3. PEPRLab Number:
(Not the USDA egg-plant establishment number)
4. Laboratory Director:
Telephone Number:
Ext:
Fax Number:
Email Address:
5. Microbiology Lab Supervisor:
Official Title:
Ext:
Telephone Number:
Fax Number:
Email Address:
6. Contact Person for PEPRLab business
Title
Telephone Number:
Ext:
Fax Number:
Email Address:
7. Person to receive egg check samples:
(Name will be included in shipping address)
FSIS FORM 10,000-8 (03/09/2016)
Page 1 of 4
OMB Approval Number 0583-0082
Expires 01/31/2018
US Department of Agriculture
According to the Paperwork Reduction Act of 1995, an agency may
Food Safety Inspection Service
not conduct or sponsor, and a person is not required to respond to,
a collection of information unless it displays a valid OMB control
Pasteurized Egg Products Recognized Laboratory
number. The time required to complete this information collection is
estimated to average 30 minutes per response, including the time
(PEPRLab) Program Information Update Request Form
for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the
collection information.
The detailed information on this update is considered proprietary and will not be released. However, a list of Recognized Laboratories
complete with addresses, telephone numbers, and contact personnel is distributed.
1.
Laboratory Name:
(Official Name)
2.
Doing business as (if applicable):
Address:
ZIP
CITY:
STATE:
CODE:
3. PEPRLab Number:
(Not the USDA egg-plant establishment number)
4. Laboratory Director:
Telephone Number:
Ext:
Fax Number:
Email Address:
5. Microbiology Lab Supervisor:
Official Title:
Ext:
Telephone Number:
Fax Number:
Email Address:
6. Contact Person for PEPRLab business
Title
Telephone Number:
Ext:
Fax Number:
Email Address:
7. Person to receive egg check samples:
(Name will be included in shipping address)
FSIS FORM 10,000-8 (03/09/2016)
Page 1 of 4
US Department of Agriculture
Food Safety Inspection Service
PASTEURIZED EGG PRODUCTS RECOGNIZED LABORATORY PROGRAM
INFORMATION UPDATE REQUEST FORM
8. Address where egg check samples are to be sent: (If different from above address)
Note: Samples are temperature critical and must be properly stored with analysis beginning on the specified date.
Address:
ZIP
CITY:
STATE:
CODE:
9. List the number of employees who participate in Salmonella analysis of pasteurized egg product surveillance samples
and fill in the
information below for each employee:
New Employee:
Yrs. of Micro
Name:
Title:
Experience
Yes/No
10. Our laboratory performs Salmonella analysis on official FSIS egg-product surveillance samples for the following egg product plant (client): (If
the lab has more than one client, please list them along with the appropriate information requested below on a separate sheet of paper and
attach to this form.)
Plant (client) Name
Establishment No
Located at
CITY:
STATE:
ZIP CODE:
11. For the plant (client) listed above, what types of official samples are analyzed? (Check all that apply.)
Dry
Liquid
Frozen
Other
12. For the plant (client) listed above, please indicate the number of official FSIS egg-product surveillance samples that you analyze per week?
Dried
Liquid
13. Does your laboratory use one of the following Salmonella cultural methods for analysis?
Yes
No
1)
The USDA, AMS Laboratory Methods for Egg Products
2)
Sec. I ('93 rev.) and Sec. VII ('94 rev.)?
Yes
No
3)
The USDA, FSIS MLG online - chapter 4?
Yes
No
4)
The FDA BAM online - chapter 5?
Yes
No
14. Does your laboratory use any rapid screening method?
Yes
No
If yes, please answer the following:
1) Is the rapid method an approved Official Method of Analysis of the AOAC INTERNATIONAL (AOAC OMA)
Yes
No
or an approved Performance Tested Method of AOAC Research Institute (AOAC -RI PTM), validated for egg
products?
2) If yes, list the name of the rapid method:
and the AOAC reference number:
FSIS FORM 10,000-8 (03/09/2016)
Page 2 of 4
US Department of Agriculture
Food Safety Inspection Service
PASTEURIZED EGG PRODUCTS RECOGNIZED LABORATORY PROGRAM
INFORMATION UPDATE REQUEST FORM
3) Is the rapid method the FSIS Rapid Screening Method as described in the MLG?
Yes
No
4) Are all positive results that are obtained by rapid screening methods followed up by
Yes
No
subculturing the sample and subsequently performing biochemical and serological
identification of any Salmonella isolates?
5). Is a rapid/miniaturized biochemical test system used for identifying Salmonella?
Yes
No
6) If yes, list the name of the test system:
and the AOAC reference number:
Yes
No
15. Are Salmonella-positive results confirmed at your laboratory?
16. If no, where is the confirmation of Salmonella-positive results conducted?
Yes
No
(NOTE: Confirmation must be completed at another laboratory currently active and in good standing in the PEPRLab Program.)
Confirming Laboratory:
PEPRLab No.
Address:
ZIP
CITY:
STATE:
CODE:
17.
Have any changes occurred in your laboratory in the last year regarding:
Yes
No
1) Methodology ........................................................................................................................................................
Yes
No
2) Personnel ............................................................................................................................................................
Yes
No
3) Facility Location ...................................................................................................................................................
18.
If yes to any of the above, explain below:
*****************************************************************************************************************************
The above information was provided by:
Name:
Title
Signature
Date
FSIS FORM 10,000-8 (03/09/2016)
Page 3 of 4
US Department of Agriculture
Food Safety Inspection Service
PASTEURIZED EGG PRODUCTS RECOGNIZED LABORATORY PROGRAM
INFORMATION UPDATE REQUEST FORM
*********************************************************************************************************************************
Instructions for Completing the Form
1. Enter the information requested and answer each of the questions as thoroughly as possible. If additional space
is needed, write “see attached” in the space after the question and attach any separate sheets of paper to the
form.
2. On page 3 & 4 circle the appropriate response (yes / no).
3. On page 4:
a.
Print the name of the person completing this form and their title.
b.
The person completing this form must also sign and date the form.
4. Submit the completed form to:
Program Manager, Pasteurized Egg Products Recognized Laboratory Program
USDA, FSIS, OPHS, LQAS
950 College Station Road
Athens, Georgia 30605
Phone: (706) 546-3559
Fax: (706) 546-3453
E-mail:
peprlab@fsis.usda.gov
FSIS FORM 10,000-8 (03/09/2016)
Page 3 of 4

Download FSIS Form 10,000-8 Pasteurized Egg Products Recognized Laboratory (Peprlab) Program Information Update Request Form

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