REPORTING: Funded Projects Pilot; Developing Standardized Forms

Pilot to Develop Standardized Reporting Forms for Federally Funded Public Health Projects and Agreements

LFFM QTR LFFM Chem_LFFM_HAF_Results_Sheet.xlsx

REPORTING: Funded Projects Pilot; Developing Standardized Forms

OMB: 0910-0909

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0910-0909 can be found here:

2024-01-22 - Revision of a currently approved collection

Document [xlsx]

Download: xlsx | pdf

Overview

Coversheet
Sample Info NOT BLINDED OR TDS
TDS Sample Info & Results
TDS Method LOD and LOQ
Allergens (HUMAN FOOD ONLY)
Amygdalin
DMAA DMBA (HUMAN FOOD ONLY)
Melamine, Cyanuric Acid
Minerals (ANIMAL FOOD ONLY)
Mycotoxins (ANIMAL FOOD ONLY)
Mycotoxins (HUMAN FOOD ONLY)
Nitrate, Nitrite
Pesticides
Sulfite
Toxic Elements (HUMAN FOOD ONLY

Sheet 1: Coversheet



Recipent Name (Select)		Select
State		Select Recipient Name
Federal Award Identification Number		Select Recipient Name
Report Frequency
Date Completed


Project Period Start Date
Project End Date
Budget Period Start Date
Budget Period End Date


Principal Investigator (PI)
PI Email
PI Phone
Has PI Information Changed?


New PI Name
New PI Email
New PI Phone



Tracks	Column1	Report	OPEI	Awardee Name	Track	Other Coversheet Responses
M - Food Defense			0	Select	All LFFM Tracks
M - Human Food			0	Select	All LFFM Tracks
M - Animal Food			0	Select	All LFFM Tracks
M - WGS			0	Select	All LFFM Tracks
M - Capability/Capacity			0	Select	All LFFM Tracks
C - Food Defense			0	Select	All LFFM Tracks
C - Human Food			0	Select	All LFFM Tracks
C - Animal Food			0	Select	All LFFM Tracks
C - Capability/Capacity			0	Select	All LFFM Tracks
R - Food Defense			0	Select	All LFFM Tracks
R - Capability/Capacity			0	Select	All LFFM Tracks
SP - IT			0	Select	All LFFM Tracks
SP - MD/V			0	Select	All LFFM Tracks
SP - Sample Collection			0	Select	All LFFM Tracks
SP - SARS-CoV-2 in Wastewater			0	Select	All LFFM Tracks
Report Frequency			0	Select	All LFFM Tracks	0
Date Completed			0	Select	All LFFM Tracks	12/30/1899
Principal Investigator (PI)			0	Select	All LFFM Tracks	0
PI Email			0	Select	All LFFM Tracks	0
PI Phone			0	Select	All LFFM Tracks	-
Has PI Information Changed?			0	Select	All LFFM Tracks	0
New PI Name			0	Select	All LFFM Tracks	0
New PI Email			0	Select	All LFFM Tracks	0
New PI Phone			0	Select	All LFFM Tracks	-

Sheet 2: Sample Info NOT BLINDED OR TDS

Instructions to complete this form are available to LFFM grantees on the Food Emergency Response Network (FERN) Portal (www.fernlab.org)

Recipient Name

State

Sample Number (ID)

LFFM Track

Commodity
(from commodity/hazard pair)

Target Species
(Animal Food ONLY)

Form of Feed
(Animal Food ONLY)

Product Description

Manufacturer/Brand

Product Code or Lot

Expiration Date

Country of Origin

Collecting Entity

Collection Location

Collection Date

Lab Receipt Date

Toxic Elements Analysis

Minerals (Animal Food ONLY)

Mycotoxins

Pesticides

Chemo-therapeutics (DMAA/DMBA)

Nutritional Analysis

Allergens

Amygdalin

Melamine/Cyanuric acid

Nitrite/Nitrate

Sulfite

EXAMPLE - PLEASE DELETE ROW

123

Chemistry Animal Food

Dairy Food + Grain/Aflatoxin

Dairy Cattle

Complete Feed - Pellet

ACME's awesome Dairy Feed

ACME

1234

1/2/22

USA

AR Inspector

(M) Manufacturer/Processor

7/14/21

7/15/21

EXAMPLE - PLEASE DELETE ROW

abc

Chemistry Animal Food

Pet Food/Macro Minerals & Moisture

Dog

RAC (raw agricutural commodity): Corn

Max's special diet

Max

3456

3/6/22

USA

FDACS

(R) Packer/Repacker

07/21/21

EXAMPLE - PLEASE DELETE ROW

CA 1234

Chemistry Animal Food

Dog and Cat Food + Grain/Aflatoxin

Cat

Complete Feed - Kibbled (dry) Pet Food

Meow Mix Tuna Delight

Meow Mix

ABC123

8/9/23

USA

UCDAVIS

(D) Retail – Grocery

08/03/21

08/06/21

EXAMPLE - PLEASE DELETE ROW

22222-2020

Chemistry Animal Food

RAC (Raw Agricutural Commodities)/Pesticides

dog

RAC (other - please list in description)

sweet potatoes

Johnson's Farms

USA

CDAI

(G) Grower

08/02/21

08/03/21

EXAMPLE - PLEASE DELETE ROW

FS-1009-2020

Chemistry Human Food

Cereal Grains/Mycotoxins

Joe's Infant Rice Cereal

Joe's Grocery

BG3209

6/23/22

China

FDACS

(D) Retail – Grocery

08/01/21

08/02/21

EXAMPLE - PLEASE DELETE ROW

2021F00231

Chemistry Human Food

Spices, powdered/Peanut and Gluten Allergens

Turmeric

Badia

3450

CAES

(D) Retail – Grocery

08/04/21

08/06/21

EXAMPLE - PLEASE DELETE ROW

CA 1235

Chemistry Animal Food

Dog and Cat Food + Grain/Aflatoxin

Cat

RAC (raw agricutural commodity): Corn

Ground Corn

7232021

UCDAVIS

(M) Manufacturer/Processor

08/06/21

08/10/21

Sheet 3: TDS Sample Info & Results

Instructions to complete this form are available to LFFM grantees on the Food Emergency Response Network (FERN) Portal (www.fernlab.org)

Lab Name

State

Sample Number (ID)

LFFM Track

Commodity
(from commodity/hazard pair)

Product Description

Brand

Product Code or Lot

UPC Code

Expiration Date

Country of Origin

Collecting Entity

Store Collected from

City where collected

Collection Date

Lab Receipt Date

ETHNIC FOODS ONLY
Please reference the originating laboratory's Sample ID Number

APROXIMATE sample size used (grams)

SRM description

Replicate (Y/N): provide separate results for each replicate

As (total)
ppb

Inorganic As (ppb)

Organic As MMA
ppb

Organic As DMA
ppb

Cd
ppb

Cr
ppb

Hg
ppb

Mn
ppb

Ni
ppb

Mo
ppb

Pb
ppb

Se
ppb

V
ppb

U
ppb

Sr
ppb

Ca
ppm

Cu
ppb

Fe
ppb

K
ppm

Mg
ppm

Na
ppm

P
ppm

Zn
ppb

Comments

Chemistry Human Food

Sheet 4: TDS Method LOD and LOQ

Instructions to complete this form are available to LFFM grantees on the Food Emergency Response Network (FERN) Portal (www.fernlab.org)
Lab Name	State	Please note approximate sample size digested; 1 g for most food, 5 g for most liquids (juice)	Element	units	MLOD	MLOQ
			As, total	ppb
			Inorganic As	ppb
Date reported:			Organic As, MMA	ppb
			Organic As, DMA	ppb
			Cd	ppb
			Cr	ppb
			Hg	ppb
			Mn	ppb
			Ni	ppb
			Mo	ppb
			Pb	ppb
			Se	ppb
		NOTE:	V	ppb
		If analyzing more than 1 type of	U	ppb
		matrix with significantly different	Sr	ppb
		digestion weights, or different	Ca	ppm
		commodities with different LOD/LOQ	Cu	ppb
		please provide MLOD/MLOQ	Fe	ppb
		information for each	K	ppm
			Mg	ppm
		If additional copies of the LOD/LOQ	Na	ppm
		information are needed, please	P	ppm
		copy paste to the right to add	Zn	ppb
		additional columns for each
			Approximate digestion weight:		grams
		The purpose of this information	Commodity:
		is to be able to evaluate the	Comment:
		upper bounds for BLOD or BLOQ
		samples

		MLOD and MLOQ do not have to
		be reported on a sample by sample
		basis

Sheet 5: Allergens (HUMAN FOOD ONLY)

Instructions to complete this form are available to LFFM grantees on the Food Emergency Response Network (FERN) Portal (www.fernlab.org)
Lab Name	State	Sample Number (ID)	Product	LFFM Track	Lab Receipt Date	Analysis Completion Date	Turn-Around-Time	Allergen Detection Overall Results	Seasame Overall Result	Seasame MLOD (mg/kg)	Sesame MLOQ (mg/kg)	Sesame Found (mg/kg)	Gluten Overall Result	Gluten MLOD (mg/kg)	Gluten MLOQ (mg/kg)	Gluten Found (mg/kg)	Milk Overall Result	Milk MLOD (mg/kg)	Milk MLOQ (mg/kg)	Milk Found (mg/kg)	Peanut Overall Result	Peanut MLOD (mg/kg)	Peanut MLOQ (mg/kg)	Peanut Found (mg/kg)	Peanut -2nd kit MLOD (mg/kg)	Peanut -2nd kit MLOQ (mg/kg)	Peanut -2nd kit (mg/kg)	Comments
EXAMPLE - PLEASE DELETE	CT	2021F00231	Turmeric	Chemistry Human Food	08/06/21	08/13/21	7	Allergens Detected					Not Detected	0.5	2.5	ND	Detected				Detected	0.5	2.5	42.3	1.2	6	51.6
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Sheet 6: Amygdalin

Instructions to complete this form are available to LFFM grantees on the Food Emergency Response Network (FERN) Portal (www.fernlab.org)
Lab Name	State	Sample Number (ID)	Product Description	LFFM Track	Lab Receipt Date	Analysis Completion Date	Turn-Around-Time	Amygdalin Overall Result	Amygdalin MLOD (ug/g)	Amygdalin MLOQ (ug/g)	Amygdalin Amount Found (ug/g)	Comments
EXAMPLE - PLEASE DELETE	MO	2021DS003	Apricot Kernels	Chemistry Human Food	08/02/21	08/23/21	21	Detected	3.2	15	123
			0	0	12/30/99		0
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			0	0	12/30/99		0

Sheet 7: DMAA DMBA (HUMAN FOOD ONLY)

Instructions to complete this form are available to LFFM grantees on the Food Emergency Response Network (FERN) Portal (www.fernlab.org)
Lab Name	State	Sample Number (ID)	Product Description	LFFM Track	Lab Receipt Date	Analysis Completion Date	Turn-Around-Time	Serving size (grams)	Overall Results	DMAA Overall Result	DMAA MLOD (mg/g)	DMAA MLOQ (mg/g)	DMAA Amount Found (mg/g)	DMBA Overall Result	DMBA MLOD (mg/g)	DMBA MLOQ (mg/g)	DMBA Amount Found (mg/g)	Comments
EXAMPLE - PLEASE DELETE	CT	2021F00231	Turmeric	Chemistry Human Food	08/06/21	08/23/21	17	1.5	Detected	Detected	1.2	12	23.1	Not Detected	1.3	13	ND
			0	0	12/30/99		0
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Sheet 8: Melamine, Cyanuric Acid

Instructions to complete this form are available to LFFM grantees on the Food Emergency Response Network (FERN) Portal (www.fernlab.org)
Lab Name	State	Sample Number (ID)	Product Description	LFFM Track	Lab Receipt Date	Analysis Completion Date	Turn-Around-Time	Overall Results	Melamine Overall Result	Melamine MLOD (ug/g)	Melamine MLOQ (ug/g)	Melamine Amount Found (ug/g)	Cyanuric Acid Overall Result	Cyanuric Acid MLOD (ug/g)	Cyanuric Acid MLOQ (ug/g)	Cyanuric Acid Amount Found (ug/g)	Comments
EXAMPLE - PLEASE DELETE	CT	2021F00231	Turmeric	Chemistry Human Food	08/06/21	08/23/21	17	Detected	Detected	0.11	0.55	235	Not Detected	1.3	13	ND
			0	0	12/30/99		0
			0	0	12/30/99		0
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			0	0	12/30/99		0
			0	0	12/30/99		0
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			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
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			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0

Sheet 9: Minerals (ANIMAL FOOD ONLY)

Instructions to complete this form are available to LFFM grantees on the Food Emergency Response Network (FERN) Portal (www.fernlab.org)
Lab Name	State	Sample Number (ID)	Target Species	Form of Feed	Product Description	Collection Location	LFFM Track	Lab Receipt Date	Analysis Completion Date	Turn-Around-Time	Moisture % (wt/wt)	Total Copper MLOD (ppm)	Total Copper MLOQ (ppm)	Total Copper Amount Found (ppm)	Calcium MLOD (ppm)	Calcium MLOQ (ppm)	Calcium Amount Found (ppm)	Phosphorus MLOD (ppm)	Phosphorus MLOQ (ppm)	Phosphorus Amount Found (ppm)	Sodium MLOD (ppm)	Sodium MLOQ (ppm)	Sodium Amount Found (ppm)	Potassium MLOD (ppm)	Potassium MLOQ (ppm)	Potassium Amount Found (ppm)	Sulfur MLOD (ppm)	Sulfur MLOQ (ppm)	Sulfur Amount Found (ppm)	Magnesium MLOD (ppm)	Magnesium MLOQ (ppm)	Magnesium Amount Found (ppm)	Chloride MLOD (ppm)	Chloride MLOQ (ppm)	Chloride Amount Found (ppm)	Comments
EXAMPLE - PLEASE DELETE ROW	AR	123	Dairy Cattle	Complete Feed - Pellet	ACME's awesome Dairy Feed	(M) Manufacturer/Processor	Chemistry Animal Food	7/15/21	8/1/2021	17	23.5	0.5	1.5	75	3	30	45	0.5	1.5	24	1	10	1230	2	20	235	5	50	124	0.2	0.6	38	1.5	15	43
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			0	0	0	0	0	12/30/99		0

Sheet 10: Mycotoxins (ANIMAL FOOD ONLY)

Lab Name	State	Sample Number (ID)	Target Species	Form of Feed	Product Description	link ingredients to feed: State/number (i.e. AR/1) if applicable DO NOT USE LAB SAMPLE #	Ingredient/Feed linkage: see drop down list of possible comments Free Text entry is allowed if provided comments do not describe the situation	Collection Location	LFFM Track	Lab Receipt Date	Analysis Completion Date	Turn-Around-Time	Mycotoxins Analysis Overall Results	Total Aflatoxin Overall Result	Aflatoxin MLOD (ug/kg)	Aflatoxin MLOQ (ug/kg)	Total Aflatoxin Amount Found (ug/kg)	Total Fumonisin Overall Result	Total Fumonisin MLOD (ppm)	Total Fumonisin MLOQ (ppm)	Total Fumonisin Amount Found (ppm)	Comments
EXAMPLE - PLEASE DELETE ROW	CA	CA 1234	Cat	Complete Feed - Kibbled (dry) Pet Food	Meow Mix Tuna Delight	CA/1		(D) Retail – Grocery	Chemistry Animal Food	07/12/21	07/19/21	7	Detected	Total Aflatoxin Detected	0.5	5	45	Total Fumonisin Not Detected	1	5	not detected
EXAMPLE - PLEASE DELETE ROW	CA	CA 1235	Cat	RAC (raw agricutural commodity): Corn	Ground Corn	CA/1		(M) Manufacturer/Processor	Chemistry Animal Food	07/12/21	07/19/21	7	Detected	Total Aflatoxin Detected	0.5	5	538	Total Fumonisin Not Detected	1	5	not detected
			0	0	0			0				0
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Sheet 11: Mycotoxins (HUMAN FOOD ONLY)

Instructions to complete this form are available to LFFM grantees on the Food Emergency Response Network (FERN) Portal (www.fernlab.org)
Lab Name	State	Sample Number (ID)	Product Description	LFFM Track	Lab Receipt Date	Analysis Completion Date	Turn-Around-Time	Mycotoxins Analysis Overall Results	Total Aflatoxin Overall Result	Aflatoxin MLOD (ug/kg)	Aflatoxin MLOQ (ug/kg)	Total Aflatoxin Amount Found (ug/kg)	Total Fumonisin Overall Result	Total Fumonisin MLOD (ppm)	Total Fumonisin MLOQ (ppm)	Total Fumonisin Amount Found (ppm)	Total Patulin Overall Result	Total Patulin MLOD (ug/kg)	Total Patulin MLOQ (ug/kg)	Total Patulin Amount Found (ug/kg)	Total Vomitoxin (DON) Overall Result	Total Vomitoxin (DON) MLOD (ppm)	Total Vomitoxin (DON) MLOQ (ppm)	Total Vomitoxin (DON) Amount Found (ppm)	Total Zearalenone Overall Result	Total Zearalenone MLOD (ug/kg)	Total Zearalenone MLOQ (ug/kg)	Total Zearalenone Amount Found (ug/kg)	Total Ochratoxin Overall Result	Total Ochratoxin MLOD (ug/kg)	Total Ochratoxin MLOQ (ug/kg)	Total Ochratoxin Amount Found (ug/kg)	Other Myctotoxins Detected LIST analyte(s)	Other Mycotoxins MLOD (ug/kg)	Other Mycotoxins MLOQ (ug/kg)	Other Mycotoxin Amount Found (ug/kg)	Comments
EXAMPLE - PLEASE DELETE ROW	FL	FS-1009-2020	Joe's Infant Rice Cereal	Chemistry Human Food	07/12/21	07/19/21	7	Detected	Total Aflatoxin Detected	0.5	5	12	Total Fumonisin Not Detected	1	5	not detected
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Sheet 12: Nitrate, Nitrite

Instructions to complete this form are available to LFFM grantees on the Food Emergency Response Network (FERN) Portal (www.fernlab.org)
Lab Name	State	Sample Number (ID)	Product Description	LFFM Track	Lab Receipt Date	Analysis Completion Date	Turn-Around-Time	Overall Results	Nitrate Overall Result	Nitrate MLOD ppm	Nitrate MLOQ ppm	Nitrate Amount Found ppm	Nitrite Overall Result	Nitrite MLOD ppm	Nitrite MLOQ ppm	Nitrite Amount Found ppm	Comments
EXAMPLE - PLEASE DELETE	CT	2021F00231	Turmeric	Chemistry Human Food	08/06/21	08/23/21	17	Detected	Detected	0.11	0.55	235	Not Detected	1.3	13	ND
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
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			0	0	12/30/99		0
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			0	0	12/30/99		0
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			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0

Sheet 13: Pesticides

Lab Name	State	Sample Number (ID)	Product Description	Target Species (ANIMAL FOOD ONLY)	Form of Feed (ANIMAL FOOD ONLY)	Collection Location	LFFM Track	Lab Receipt Date	Analysis Completion Date	Turn-Around-Time	Pesticide Analyte Overall Results	Pesticide Analyte (select from drop down list)	Pesticide Analyte MLOD (ug/g)	Pesticide Analyte MLOQ (ug/g)	Pesticide Analyte Amount Found (ug/g)	Comments
Pesticide results are being reported differently this year
If multiple pesticides are detected, please list each
detected pesticide on a separate row
If multiple pesticides are detected, please list each	CO	22222-2020	sweet potatoes	dog	RAC (other - please list in description)	(G) Grower	Chemistry Animal Food	09/15/20	10/10/20	25	Detected - Violative	2,3,5,6-Tetrachloroaniline	0.0031	0.0102	52.3
EXAMPLE - PLEASE DELETE ROW	CO	22222-2020	sweet potatoes	dog	RAC (other - please list in description)	(G) Grower	Chemistry Animal Food	09/15/20	10/10/20	25	Detected - Not Violative	Acephate	0.0031	0.0102	0.1
EXAMPLE - PLEASE DELETE ROW	CO	22222-2020	sweet potatoes	dog	RAC (other - please list in description)	(G) Grower	Chemistry Animal Food	09/15/20	10/10/20	25	Detected - Not Violative	Azoxystrobin	0.0031	0.0102	TR (0.008)
EXAMPLE - PLEASE DELETE ROW	FL	abc	Max's special diet	Dog	RAC (raw agricutural commodity): Corn	(R) Packer/Repacker	Chemistry Animal Food	07/21/21	08/14/21	24	No Pesticides Detected
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Sheet 14: Sulfite

Instructions to complete this form are available to LFFM grantees on the Food Emergency Response Network (FERN) Portal (www.fernlab.org)
Lab Name	State	Sample Number	Product	LFFM Track	Lab Receipt Date	Analysis Completion Date	Turn Around Time	Sulfite Analysis Overall Results (detected / not detected)	Sulfite LC/MS MLOD (ug/g)	Sulfite LC/MS MLOQ (ug/g)	Sulfite LC/MS Amount Found (ug/g)	Sulfite Monier Williams MLOD (ug/g)	Sulfite Monier Williams MLOQ (ug/g)	Sulfite Monier Williams Amount Found (ug/g)	*Barium Sulfate Confirmation Amount Found (ppm) if applicable**	Comments
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
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			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0
			0	0	12/30/99		0

Sheet 15: Toxic Elements (HUMAN FOOD ONLY

Instructions to complete this form are available to LFFM grantees on the Food Emergency Response Network (FERN) Portal (www.fernlab.org)
Lab Name	State	Sample Number (ID)	Product Description	LFFM Track	Lab Receipt Date	Analysis Completion Date	Turn-Around-Time	Toxic Metals Analysis Overall Results	Total Arsenic Overall Result	Total Arsenic MLOD (ug/kg)	Total Arsenic MLOQ (ug/kg)	Total Arsenic Amount Found (ug/kg)	Inorganic Arsenic Overall Result	Inorganic Arsenic MLOD (ug/kg)	Inorganic Arsenic MLOQ (ug/kg)	Inorganic Arsenic Amount Found (ug/kg)	Total Cadmium Overall Result	Total Cadmium MLOD (ug/kg)	Total Cadmium MLOQ (ug/kg)	Total Cadmium Amount Found (ug/kg)	Total Chromium Overall Result	Total Chromium MLOD (ug/kg)	Total Chromium MLOQ (ug/kg)	Total Chromium Amount Found (ug/kg)	Total Lead Overall Result	Total Lead MLOD (ug/kg)	Total Lead MLOQ (ug/kg)	Total Lead Amount Found (ug/kg)	Total Mercury Overall Result	Total Mercury MLOD (ug/kg)	Total Mercury MLOQ (ug/kg)	Total Mercury Amount Found (ug/kg)	Total Copper Overall Result	Total Copper MLOD (ug/kg)	Total Copper MLOQ (ug/kg)	Total Copper Amount Found (ug/kg)	Total Selenium Overall Result	Total Selenium MLOD (ug/kg)	Total Selenium MLOQ (ug/kg)	Total Selenium Amount Found (ug/kg)	Total Manganese Overall Result	Total Manganese MLOD (ug/kg)	Total Manganese MLOQ (ug/kg)	Total Manganese Amount Found (ug/kg)	Total Molybdenum Overall Result	Total Molybdenum MLOD (ug/kg)	Total Molybdenum MLOQ (ug/kg)	Total Molybdenum Amount Found (ug/kg)	Total Nickel Overall Result	Total Nickel MLOD (ug/kg)	Total Nickel MLOQ (ug/kg)	Total Nickel Amount Found (ug/kg)	Total Thallium Overall Result	Total Thallium MLOD (ug/kg)	Total Thallium MLOQ (ug/kg)	Total Thallium Amount Found (ug/kg)	Total Zinc Overall Result	Total Zinc MLOD (ug/kg)	Total Zinc MLOQ (ug/kg)	Total Zinc Amount Found (ug/kg)	Comments
EXAMPLE - PLEASE DELETE ROW	FL	FS-1009-2020	Joe's Infant Rice Cereal	Chemistry Human Food	06/03/20	07/10/20	37	Detected	Total Arsenic Detected	0.0012	0.0035	125.2	Inorganic Arsenic Detected	3.1	10.5	105.2	Total Cadmium Not Detected	3.1	10.5	ND					Total Lead Not Detected	3.1	10.5	ND	Total Mercury Not Detected	01/02/00	01/09/00	ND																													Infant Rice Cereal
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File Type	application/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified	0000-00-00
File Created	0000-00-00