LFFM QTR LFFM Data Template Micro HAF Product Testing 2023.xlsx

Standardized Reporting Forms for Federally Funded Public Health Projects and Agreements

LFFM QTR LFFM Data Template Micro HAF Product Testing 2023.xlsx

OMB: 0910-0909

Document [xlsx]
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Overview

Coversheet
HF and AF Data


Sheet 1: Coversheet









OMB Number: 0910-0909 Exp Date: XX/XX/XXXX See bottom of page for PRA statement




























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






Sheet 2: HF and AF Data

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 Category (Assigned) Target Species (animal) - AF Track Only Form of Feed - AF Track Only Product Description Manufacturer/Brand Product Code or Lot Expiration Date Country of Origin Collecting Entity Collection Location Collection Date Lab Receipt Date Salmonella Analysis Start Date Salmonella Screen Result Salmonella Confirmatory Result Salmonella Final Result Salmonella Serotype Salmonella Analysis Completion Date Salmonella Analysis Turn-Around-Time BSE Prohibited Materials Analysis Start Date BSE Prohibited Material Final Result BSE Analysis Completion Date BSE Analysis Turn-Around-Time L. monocytogenes Analysis Start Date L. monocytogenes Screen Result L. monocytogenes Confirmatory Result L. monocytogenes Final Result L. monocytogenes Analysis Completion Date L. monocytogenes Analysis Turn-Around-Time EHEC/STEC Analysis Start Date EHEC/STEC Screen Result EHEC/STEC Confirmatory Result EHEC/STEC Final Result EHEC/STEC Analysis Completion Date EHEC/STEC Analysis Turn-Around-Time Cyclospora cayetanensis Analysis Start Date Cyclospora cayetanensis Final Result Cyclospora cayetanensis Analysis Completion Date Cyclospora Analysis Turn-Around-Time WGS Date Isolate Submitted WGS Isolate ID WGS Results (Serotype, Clusters, etc.) WGS Date Data Submitted WGS Analysis Turn-Around-Time Norovirus Analysis Start Date Norovirus Final Result Norovirus Analysis Completion Date Norovirus Analysis Turn-Around-Time Camplylobacter Analysis Start Date Campylobacter Final Result Campylobacter Analysis Completion Date Campylobacter Analysis Turn-Around-Time Other Analyte1 (Pick from Drop Down) Other Analyte1 Result Comments
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