National Marine Mammal Tissue Bank Form

NIST Sample Processing Page 1

National Marine Mammal Tissue Bank Form
Field ID:

Other ID Number:
Genus species:

Common Name:
Collection
Type:

Single Strand

Biopsy

Mass Strand
UME

Repeat Event
Live Capture Release

Rescue

Other (specify):

Condition:

(choose one)

Alive
If euthanized:

Incidental Take

(choose one)

(specifiy):

Fresh Dead (Code 2)

Fisheries
or
Other

Was animal in rehabilitation?

Euthanized

Yes

No

Where:

With what:

If yes:

How much:

From: dd / mm / yy

State:

Bow/Arrow
Gunshot

Subsistence

(choose one)

Other (specify):

To: dd / mm / yy

(please attach cllinical/medical records)

Where:
Animal Location:

Clubbed

County:

City/Island/Community:

Ocean/Bay/Sea:
Locality Details:
N (dec degrees)

Latitude:
Time of death.........

dd / m / yy

hr

Longitude:

Place of Death:

(Zulu)

Internal body temp. of animal:

If transported before tissue removal:

W (dec degrees)

Vehicle Type:

C

F

Rigor?

Yes

No

Length of Transport:

Ambient weather condition:
Remarks:
Time of tissue removal ....

dd / mm / yy

(Zulu)

hr

Place of tissue removal:

Internal body temp. of animal just before tissue removal:
Transportation storage:

If transported before processing:

C

Dry ice

Wet ice

Other:

Teflon bag

Teflon jar

Other:

Ambient weather condition:
Interim storage of tissue:
Remarks:

Time of tissue processing.... dd / mm / yy

hr

(Zulu)

Place of tissue processing:
Ambient temperature at processing:

Time of interim freezing.....

dd / mm / yy

hr

Time shipped to NIST........

dd / mm / yy

hr

dd / mm / yy

hr

(Zulu)

(Zulu)

Time received at NIST.......

Freezer type:

LN 2

-80° C

-20° C

Other:

(Zulu)

Additional comments:

Sample weights:

Blubber (g):

A
B

OMB Control #: 0648-0468
Expiration Date: XX/XX/20XX

Liver (g):

Kidney (g):

Whole
Blood (mL):

Plasma (mL)

Serum (mL):

Other:

F

Animal Information Page 2

National Marine Mammal Tissue Bank Form
Genus species:

Field ID:

Female

Sex:

Male

Unknown
Age Class:

(choose one)

Total length:

cm

in

Actual

Estimated

Total weight:

kg

lb

Actual

Estimated

Age:

Adult

Subadult

Actual

Pup/calf

Yearling

Estimated

Method Used:

(choose one)

Unknown
Epiphysis:

Open

Closed fused

Photo

Testis/Ovaries:

cm

Fetus length:

Bone

Ear Plugs

(Please attach copy of photo or slide)

Mid-Width:

Mid-depth:

Left:

(circle one)

Lactating

Baleen

Other:

Slide

Length:

Pregnant

Teeth (GLG's)

Disposition of specimen:

Fused invis

Reproductive condition:
Sexually Mature

Date aged: dd /mm / yy

By whom:

Right:

Corpora lutea #:

Corpora albicantia #:

Weight:
cm

g

in

oz

Corpora hemmorghagicum #:

in

Specify Units of Measurement:

cm

in

Cetaceans:
Snout to ant. ins. of flipper:

Girth:

Axillary:

Snout to center of genital aperture:

Max:

Snout to center of anus:

Anal:

Flipper length:

(Location)

Thoracic:

Blubber thickness:

Fluke width:

Dorsal:

Fluke notch to anus:

Lateral:

Tooth counts: ..............

UL/LL:

Ventral:

UR/LR:

Pinnipeds:
Nose to tail length:

Ant. length of hind flipper:

Ant. length of foreflipper:

Blubber thickness over post. end of sternum:

Axillary girth:

Other blubber thickness:

(Location)

Bacculum length:
Polar Bears:
Girth of neck of axis:

Skull length:

Girth of neck at shoulders:
Sea Otters:
Snout to angle of mouth:

Right forepaw width:

Skull length:

Skull width:

Axillary girth:

Tooth Wear:

None: Little:

Estimate of body fat stores:

Subcutaneous:
Groin:
Kidneys:
Mesenteric:

OMB Control #: 0648-0468
Expiration Date: XX/XX/20XX

Heavy

cm

Medium

Average:

Light
Excessive:

None

Additional Samples List Page 3

National Marine Mammal Tissue Bank
Field ID Number:

Genus species:

Was animal necropsied?

Yes

No
dd / mm / yy

Necropsied by:

(Please attach necropsy report)

Date

Samples collected:
Histological samples:
Individual/Organization:

Final destination:

Tissues sampled:

Liver

Kidney

Blubber

Stomach

Heart

Intestine

(Choose all
that apply)

Lung

Pancreas

Adrenals

Brain

Muscle

Skin

Trachea

Spleen

Thymus

Colon

Thyroid

Esophagus

Other:

(Please list)

Lymph Nodes:

Submandibular

Prescapular

Axillary

Hilar

Mesenteric

Other l.n.:

Other samples collected:

Type of storage:
(Z-frozen, F-formalin, DMSO, ETOH)

Teeth:
Genetics (skin):
Skull:
Reproductive tract:
Mammary tissue:
Ovaries:
Gonads/testes:
Parasites:

Number of parasites: ...........
List type and location: ...........
Stomach:

List contents if applicable: .......
Other contaminant samples:

(List tissue type, storage
type and where located)

Additional samples:

(List tissue type, purpose of
collection, storage type and
where located)

OMB Control #: 0648-0468
Expiration Date: XX/XX/20XX

0-20

21-100

101+

Where located (Ind./Org.):

National Marine Mammal Tissue Bank
Field ID Number:

General Notes Page 4

Genus species:

Photos taken of animal:

Yes

No

Video taken of animal:

Yes

No

Digital

Film

If yes, how many?

(Please send copy with samples for NIST archive)

Disposition:

(primary location
for photos and/or
video)

General comments:

(Field notes)

General appearance of individual:

General appearance of organs:

NMMTB Protocol:

Standard

Modified

Please note any modifications:

A copy of this form and Level A Data Form
should be shipped with samples to:

Form prepared by:
Name (Print)
Affiliation (Print)

OMB Control #: 0648-0468
Expiration Date: XX/XX/20XX

ATTN: Rebecca Pugh or Amanda Moors
NIST Biorepository
Hollings Marine Laboratory
331 Fort Johnson Rd
Charleston, SC 29412
843-460-9864 / 843-460-9814

National Marine Mammal Tissue Bank

Chain of Custody Page 5

NMMTB's Chain of Custody
Field ID Number:
Other ID Number:
NMMTB Storage ID Numbers:

dd / mm / yy

1.
Collector's signature

Method of transfer to processing stage

Date
dd / mm / yy

2.
Processor's signature

Method of transfer to shipping stage

Shipper to NMMTB's signature

Method of transfer to NIST Biorepository

Date
dd / mm / yy

3.

Date
dd / mm / yy

4.
Receiver's signature

Date

Each person in possession of the tissue must sign and date the form.

PAPERWORK REDUCTION ACT INFORMATION
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply
with an information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently valid
OMB Control Number. The approved OMB Control Number for this information collection is 0648-0468. Without this approval, we could not conduct this
survey/information collection. Public reporting for this information collection is estimated to be approximately 45 minutes per response, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information
collection. All responses to this information collection are mandatory. Send comments regarding this burden estimate or any other aspect of this
information collection, including suggestions for reducing this burden to the National Marine Fisheries Service at: 1315 East West Highway, 13th Floor,
Silver Spring, MD 20910, Attn: Sarah Wilkin, Coordinator, Marine Mammal Health and Stranding Response Program,
[email protected] if desired.

OMB Control #: 0648-0468
Expiration Date: XX/XX/20XX