Form PHS-3 __ __ __ _Request for Field Microbiology Testing __ __ |S- - |
Site:Code |__|__|__|__| Site Name:________________ Company |__|__|_________ | |
__ __ __ __ __ __ __ __ __ __ Lab.Ref.
Species/Type|__|__| Houses |__|__|__|__|__|__| Age |__|__| weeks/days Date Hatched __/__/__
Sampled by :__________________ Date Sampled __/__/__
Tests Required (Delete as appropriate): Salmonella/Campylobacter/__________________________
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Samples submitted (please attach list if appropriate):
Number of Samples Number of Samples
Hatchery culled chicks- - - - -|___| Environmental Sample - - - - - |___|
D.O.A. Chicks - - - - - - - - -|___|
Chick Box Liners - - - - - - - -|___| ___
1-4 Day Chick Mortality - - - - |___| Feed - - - - - - - - - - - - - |___|
Cloacal Swab- - - - - - - - - - |___| Feed Ingredients - - - - - - - |___|
Composite Faeces - - - - - - - |___|
Litter - - - - - - - - - - - - -|___| ___
Carcases - - - - - - - - - - - -|___| Other:_________________________ |___|
Comments_:________________________________________________________________________________
For Office Use Only : Date Received __/__/__ Condition __________ Media System |___|
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Form PHS-3 Salmonella | HINTS FOR GOOD SAMPLES
| ======================
| 1. Plan for samples to arrive on a week-day.
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| 2. Use appropriate sample numbers and
URGENT PATHOLOGICAL SPECIMEN (S) | containers - consult laboratory if in
====== ===================== | any doubt.
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To:| | | 3. Package in a secure leak-proof manner.
| POULTRY HEALTH SERVICES | | If not possible to dispatch immediately
| Poultry Health Centre | | keep samples refrigerated (not frozen).
| Main Site Lane | |
| Dalton | | 4. Complete this form, fold in 4 and place
| Thirsk | | in a "Documents Enclosed" pouch with the
| North Yorkshire | | address visible. Peel off backing and
| YO7 3JA | | stick to outside of package.
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