10,120-1B Microbiology Form

OMB Control lNumber: 0583-0082
Expiration Date:
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
valid OMB control number. The valid OMB control number for this information collection is 0583-0082. The time required to complete this information collection is estimated to average
5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information.

Instructions: FSIS: Complete items 1 through 6.

U.S. Department of Agriculture
Food Safety and Inspection Service
Accredited Laboratory Program

Microbiology Form
1. ALP Lab Number:

2. Analysis:

3. Date Sent: (mm/dd/yyyy)

4. Matrix Type: (if applicable)

Laboratory: Report analytical findings under item 6. See the
Instruction page for additional instructions.

6. Laboratory Address:

5. Due Date for Results: (mm/dd/yyyy)

Email Results by the Due Date to: [email protected]
6. Report as Positive or Negative and Report Serotype, if applicable:

Result

Sample Number

Serotype

Submitted by Signature

Printed Name

DRAFT

FSIS 10,120-1b (2023)

Title

REPLACES FSIS 10,120-1 (02/02/2017) WHICH IS OBSOLETE

Date: (mm/dd/yyyy)

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Instructions for Handling PT Samples and Reporting Result
This is a laboratory sample; not for consumption

- Test materials contain viable micro-organisms and are supplied on the understanding that the purchaser has suitably competent and qualified personnel
to handle them safely
. Test materials must only be opened in a laboratory by qualified personnel.- On receipt of test material, record the date and store refrigerated at 2-8°C
- The microbiological test material represents a ‘real’ food sample, which may or may not contain the target organism, at a range of inoculum levels.
Background flora may also be present.- Test the entire sample; do not sub-divide prior to dilution.
- Reconstitute the test material according to the instructions outlined below.
1. Divide the matrix into 25g portions for each sample to be tested.
2. Aseptically remove the cap and rubber stopper from the first vial and reconstitute the freeze dried test material by adding 1 ml of chosen enrichment
broth.
3. Replace the stopper and shake to dissolve.
4. Leave the test material to resuscitate at room temperature for 60-90 minutes.
5. Add 225ml of your chosen enrichment broth in chosen sample container containing 25g sample.
6. Mix the matrix material thoroughly and leave at room temperature for 60-90 minutes.
7. After the 60 -90 minute period add 1ml of the vial contents prepared in step 2 to the matrix preparation from step 6.
8. Test for the target organism(s) using your routine laboratory methods.
9. Laboratory Program (ALP). Repeat steps 2 to 9 for each additional vial.- Treat the sample in the same manner as any routine sample except
as noted by the FSIS Accredited
-

Laboratories may not subcontract out any PT samples. If a laboratory is unable to analyze samples, ALP personnel should be notified.- No comments
should be made on the PT Sample Results Form.- If PT samples are received in poor condition, the ALP should be notified immediately by email
([email protected]). The ALP may replace samples, or an excuse from reporting results may be authorized\

-

All entries on forms and reports should be clearly typed or legibly written on the original.- Name and title of authorized person signing form should also
be printed below signature on all forms and reports provided by the ALP.- Results may be submitted by mail or email. If submitting results by email,
submitting results via email. Please keep this email for your records. If you do not receive an email confirmation within three business days, contact the
to verify that the results were received.

-

PT sample results must be received on or before the due date indicated on the report form. Late results are subject to rejection. Failure

-

PT sample results could result in revocation of accreditation

-

ALP will consider claims regarding PT sample results lost in the mail only with acceptable proof of mailing. Acceptable proof of mailing includes receipts
from the U.S. Post Office or overnight/express delivery carriers.

-

Requests for "Excused Absences" for PT sample results must be in writing, explain the reason for the request, and be received by ALP address below before
the due date.

-

Laboratories may not be excused more than twice per accreditation period. Any further requests to be excused will be reviewed on a case basis by ALP staff.

-

If a laboratory believes that there was a data processing error in the PT report at FSIS, the laboratory may request a review. The request must be in writing
and received by ALP at the address below within 30 days of the data of the report in question.

-

Retain a copy of your PT Sample Results for your records. All correspondence (including comments, suggestions, and appeals) should be addressed to:
Accredited Laboratory Program
USDA, FSIS, OPHS, LQARCS
Russel Research Center
950 College Station Road
Athens, GA 30605

DRAFT
or Email to:

[email protected]

FSIS 10,120-1b (2023)

REPLACES FSIS 10,120-1 (02/02/2017) WHICH IS OBSOLETE

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