Fillable Ont.Hatch AHL Form %282019-02-07%29 FILLABLE

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Ont.Hatch AHL Form %282019-02-07%29 FILLABLE

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ONTARIO HATCHERY & SUPPLY
FLOCK POLICY SUBMISSION FORM
Lab use only
Important. Please read. Contact Information must be supplied with all samples submitted for testing to the Animal Health Lab (“AHL”). Agricultural animal testing carried out through AHL is
subsidized by the Government of Ontario. By submitting samples for testing to AHL, the submitter acknowledges that s/he is the owner or is a duly authorized agent of the owner. The
submitter acknowledges and agrees that AHL may share test results and contact information as it deems necessary for the purposes of relevant legislation regarding reportable or notifiable
diseases and for the purpose of surveillance of animal or public health in Ontario.
Clinic No. Owner Unique ID
(max. 40 characters)
Clinic
Address Postal Code Address
City Phone Premises ID Barn Postal Code
Veterinarian Fax Phone Email
Email Farm Fax
Barn/Pen/Floor/Batch ID Flock ID
Turkey
Chicken
Other
Circle applicable commodity
Broiler Breeder Broiler/Breeder
Layer Layer/Breeder Meat
Exhibition Other _______
Number of birds
# in flock
# tested
Type of specimen Fluff Blood Env. Swab
OHSFP
Susp. Reactor Other Boots Env. Swab
EU
Egg Shell Meconium
P.T.-tube
MGMS,turkey
MGMS,chicken
M.G.-H.I.
M.S.-H.I.
MME
M.M.-H.I.
CAV-ELISA
NDV-ELISA,turkey
NDV-ELISA,chicken
PMV3-HI
IBV - ELISA
IBDV - ELISA
REO - ELISA
AEV - ELISA
AIV - AGID
Other
Count
Culture
Export surveillance
Suspicious reactor/
excess mortality
salmh
mgmst
mgmsc
mgh
msh
mme
mmh
cav1
ndvt
ndvc
pm3
ibv
ibdxr
reove
aev
aif
_________
hatch & hsfe
hsfe
pull
hsfrem
Your Lab # Identification or Machine Your Lab # Identification or Machine
Specimens (Continue on AHL worksheet)
Comments/History (Continue on AHL worksheet)
FOR LABORATORY USE ONLY
Inspector________________________ Hours__________________ Received Via Courier Drop-off Mail Other Initials_________
AHLHatch (2019-02-07)
Band Numbers
Any questions? Please contact the lab.
Email: ahlinfo@uoguelph.ca
Website: http://ahl.uoguelph.ca
AHL GUELPH: 519-824-4120 ext: 54530, Fax: 519-821-8072
AHL KEMPTVILLE: 613-258-8320, Fax: 613-258-8324
Page 1 of 2
Reason for Testing: check all that apply
EU Export
OHSFP
Project
Other ___________________
Export Date _________________
AHL - Guelph Courier Address
UoG Animal Health Lab-PAHL
419 Gordon Street-Bldg 89
Guelph, ON N1G 2W1
Attn: Specimen Reception
Animal Health Laboratory
Laboratory Services Division
Univ of Guelph/Kemptville
Campus
79 Shearer Street
Kemptville, Ontario K0G 1J0
SAMPLES TAKEN Date: _________/_____/_____(yyyy/mm/dd) Time of day _____:_____ Date sent________/____/____ (yyyy/mm/dd)
SUBMITTED BY Veterinarian Owner Agent BILL Veterinarian Agent
Age weeks
Sex (check) M F
Breed
ANIMAL HEALTH LABORATORY
ADDITIONAL ID WORKSHEET
Comments/History (Continued)
ID# Identification ID # Identification
Page 2 of 2
AHLHatch (2019-02-07)
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Ont.Hatch AHL Form %282019-02-07%29 FILLABLE

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Completed 18 May 2020

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