PHU Request for Specimen Collection

To request an animal specimen collection for rabies testing please complete and submit one form per animal.  

If a required field is not applicable to your case please enter N/A.

If you realize after you have submitted your form that there was an error entered please do not resubmit onlineInstead email rrp@oavt.org with the corrections needed.

If you require a copy of this completed submission form, print this page before clicking submit.

Request for specimen collection should not occur until the PHU has confirmation that the animal is deceased and has arrived at the collection location.

If a collection is occurring at a residence the PHU should ensure the following:

  1. There is an area out of public view for the collection to take place
  2. The homeowner approves of the collection occurring on their property
  3. The homeowner understands the collection procedure
  4. The homeowner understands it is their responsibility to dispose of the remains afterwards
  5. The homeowner has a fridge or freezer where the animal can be stored until collection occurs when outdoor temperatures exceed five degrees celsius.

If this criteria can’t be met the animal should be transported to a veterinary hospital or animal shelter prior to submission request.

All items indicated below must be provided by the health unit at the time of the request in order for the OAVT to:

  1. Fill out the necessary laboratory/shipping paperwork
  2. Dispatch a RVT to do the collection

 

Confirmation of Submission:

Please note: If you are using Internet Explorer as your web browser you may not be able to submit this form properly due to the limitations of this aging web browser. This form will work best using Google Chrome and is also compatible with Microsoft Edge, Safari or Firefox browsers.

To ensure your submission has been completed please look for the pop up window at the top of this page confirming your submission has been received, as well as a confirmation email sent to the email address included in the field “Email address for health unit contact person for any isses pertaining to the details of this case.”

PHU Request for Specimen Collection FORM

Animal Information

Specimen Weight *
(animals full body weight)
Sex: *
Clinical signs prior to death/euthanasia (please check all those that apply): *
Cause of Death *
Reason for Euthanasia (by Veterinarian, Animal Services/Shelter, Wildlife Rehabilitator): *
Current on rabies vaccinations *

Animal’s location prior to death

Please include the location where the animal lived before being euthanized

GPS Co-ordinate tools: http://www.geocoder.ca

Specimen Collection Location Information

Exact address for collection location (including street address, city and postal code)
Location

Location Contact Information

For the location where specimen collection is to occur:

Exposure Information:

Please note:

The CFIA follows the World Health Organization Expert Consultation on Rabies (2nd Report, 2013) definitions of exposure to determine eligibility for rabies testing.

Exposures must be WHO Category II or III to be eligible for testing at the CFIA (except for bats-see below note).

Category III exposure is defined as single or multiple transdermal bites or scratches, licks on broken skin, or contamination of mucous membranes with saliva.

Category II exposure is defined as nibbling of uncovered skin or minor scratches or abrasions without bleeding.

Category I exposure is defined as touching an animal or licks on intact skin, even if the animal is rabid. For humans, it also includes feeding of animals. There is no possibility of exposure to the rabies virus through these types of contact.

If you have determined a potential bat exposure is not a WHO Category II or III exposure, but an exposure can’t be ruled out (as per your PHU’s guidelines) please use the option “Other (for bats only, if confirmed to be found in close proximity to a human but direct contact can’t be confirmed or ruled out. e.g. Bat found in baby’s room while sleeping)” below.

Type of exposure: *
Part of body exposed (check off all that apply):
Were there any domestic animals (dogs,cats,livestock) exposed to the animal being tested? *
Was the additional domestic animal exposure: *

Affected party:

Section

Health Unit Information:

Section

Specimen Shipping and Result Contact Information

Do you require a copy of your submission form?

To print a copy of your submission form please do the following:

1. Before submitting your form, right click your mouse and select “print”. Then select the destination printer you would like to print from and follow the remaining prompts to complete printing.

To save a copy of your submission form please do the following:

1. Before submitting your form, right click your mouse and select “save as”, then save your document to the appropriate folder.

or

2. Before submitting your form, right click your mouse and select “print”, then chose the printer destination that allows you to “save as pdf”. Then save the document to the appropriate folder.

or

3. After printing your document (as instructed above at the top of this section),scan it into your computer and save it in the appropriate file.