"Salmonella Enteritidis (Se) Sample Submission Form" - Montana

Salmonella Enteritidis (Se) Sample Submission Form is a legal document that was released by the Montana Department of Livestock - a government authority operating within Montana.

Form Details:

  • Released on September 17, 2015;
  • The latest edition currently provided by the Montana Department of Livestock;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Montana Department of Livestock.

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Download "Salmonella Enteritidis (Se) Sample Submission Form" - Montana

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Lab Use Only:
Click Box to Clear Form
Accession #:
Number of Samples:
Montana Veterinary Diagnostic Laboratory
MVDL-Received Date/Time/By:
Carrier:
Section-Received /Date/Time/By:
1911 W Lincoln, Bozeman, MT 59718 Phone 406-994-4885 Fax 406-994-6344
Email:
Website:
Specimen Condition Acceptable:
livdiagnosticlab@mt.gov
www.liv.mt.gov/lab
Salmonella Enteritidis (SE) Sample Submission Form
Yes
No; Reason/Initials:
Owner/ Submitter:
Billing Address:
Address:
Copy of Report To:
Colony
Wilcox
Other:
Phone:
Email:
Fax
Email
Other:
Fax:
Other:
Fax/Email/#:
Ranch/ Collection Site:
Sample Profile:
Chick Papers
Collection Date/Time:
Pullets
Weeks:
Sampled By
:
Pre-Production
Weeks:
(please print/type)
Sampled By
:
Mid-Production (Layers)
Weeks:
(signature affixed)
Number/Type Specimens:
Push Outs
Weeks:
Flock ID:
House/Barn ID:
Other:
Test Procedure Requested
:
PCR
Culture
(choose one)
Sample ID Number:
Lab Use Only:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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12.
F:\USER\QMS\Submission Instructions & Forms\SE\5.7.100.115 MVDL SE Sample Submission Form.docx\ Revision Date 9-17-15 PB\ Page 1 of 2
Lab Use Only:
Click Box to Clear Form
Accession #:
Number of Samples:
Montana Veterinary Diagnostic Laboratory
MVDL-Received Date/Time/By:
Carrier:
Section-Received /Date/Time/By:
1911 W Lincoln, Bozeman, MT 59718 Phone 406-994-4885 Fax 406-994-6344
Email:
Website:
Specimen Condition Acceptable:
livdiagnosticlab@mt.gov
www.liv.mt.gov/lab
Salmonella Enteritidis (SE) Sample Submission Form
Yes
No; Reason/Initials:
Owner/ Submitter:
Billing Address:
Address:
Copy of Report To:
Colony
Wilcox
Other:
Phone:
Email:
Fax
Email
Other:
Fax:
Other:
Fax/Email/#:
Ranch/ Collection Site:
Sample Profile:
Chick Papers
Collection Date/Time:
Pullets
Weeks:
Sampled By
:
Pre-Production
Weeks:
(please print/type)
Sampled By
:
Mid-Production (Layers)
Weeks:
(signature affixed)
Number/Type Specimens:
Push Outs
Weeks:
Flock ID:
House/Barn ID:
Other:
Test Procedure Requested
:
PCR
Culture
(choose one)
Sample ID Number:
Lab Use Only:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
F:\USER\QMS\Submission Instructions & Forms\SE\5.7.100.115 MVDL SE Sample Submission Form.docx\ Revision Date 9-17-15 PB\ Page 1 of 2
For information on how to collect environmental samples (swabs) from a poultry house, refer to the FDA
http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Eggs/ucm285101.htm
Website:
C
OLLECTION
1. Disinfect the top of a can of evaporated milk and open with a disinfected can opener
2. Moisten the drag swab with evaporated milk and collect the sample
3. Place each drag swab in a separate 18 ounce Whirl-Pak
bag containing sufficient evaporated milk (about 1 tablespoon) to keep the swab moist in transit
TM
 An 18 ounce bag enables us to add test materials to your sample
 PLEASE DO NOT use small sandwich bags or snack bags or an excess of evaporated milk
4. Press the air out of the Whirl-Pak
TM
bag and seal by twirling the bag three times while holding the wire end tabs, or folding the end over tightly three times
5. Bend the wire tabs over the bag edges to hold the seal
6. Make sure the outside of the Whirl-Pak
bag is clean, dry and clearly labeled to correspond to the SE Submission Form
TM
 Please use a separate SE Submission Form for each barn sampled
7. Place all of the sealed Whirl-Pak
bags from a barn in a gallon Ziploc® bag
TM
8. Specify PCR or Culture test on SE Submission Form
9. Complete the SE Submission Form and place it in a separate, clean Ziplock® bag to prevent contamination of the paperwork if a leak should occur
10. Keep the samples cool (40˚F – 45˚F) during collection if sample collection requires more than 6 hours
Specimen ID –
Remove Perforation/Add milk/Add swab
Twirl to close
Press tabs to seal
S
HIPPING
1. Place samples in a shipping container with frozen gel paks to keep samples cool (40˚F – 45˚F)
2. Ideally, samples should be shipped the same day as collected and received by MVDL within 48 hours
3. Ship to : MVDL, 1911 West Lincoln, Bozeman, MT 59718 via priority overnight delivery (FedEx or UPS)
4. Notify MVDL by calling 406-994-4885 with shipment date and number of samples in shipment
5. For best turn-around-time, ship on Monday and Tuesday
6. If chick paper collection occurs on a Friday, refrigerate samples and ship on Monday
 Do not ship samples on Friday or Saturday
R
T
S
ECEIPT AND
ESTING OF
AMPLES
1. Upon arrival, MVDL will assess and record transit time and temperature to verify that samples are acceptable for testing
2. MVDL will notify the submitter prior to testing if sample quality or sample identification is questionable
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