GOV.UK



|Department for Environment, Food and Rural Affairs |[pic] |

|Scottish Government | |

|Welsh Government | |

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|Sam Data Fix Request |

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|All fields marked with *are mandatory. If an incomplete form is received it may be returned without action. |

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|Customer Name * |           | | APHA COMPLETION ONLY |

| | | |Customer ID |           |

|CPH/CPHH * |      | |Work Schedule ID |           |

| | | |WSA ID |           |

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|Work Schedule Activity (WSA) ID|      | | |

|* | | | |

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|Customer Address * |      |

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| | Postcode*:       |

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|Test Performer * |      |Delivery Partner (if |      |

| | |applicable) | |

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|Official Veterinarian (OV) |      |

|Practice (incl. postcode) * | |

| |Postcode*:       |

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|Contact Details * We may need to speak to you about this issue |

|Name |      |

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|Telephone No. |      |

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|Email Address |      |

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|Test Date |      |Test Type|      |Test part (e.g. P1, C3) |      |

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|If changing test status of an animal from Not Tested to Tested, please confirm: |

|if flat clear, or |

|clearly show the Avian and Bovine readings for TT1 and TT2, plus the reaction descriptions (SO, C or None) |

|the DNA tag for reactors |

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|If you have incorrect readings against animals add the correct readings for each animal below: |

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|Official Animal Identifier |

|If changing test status of an animal from Tested to Not Tested, please confirm the not tested reason below: |

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|Official Animal Identifier |Not Tested Reason |

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|      |      |

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|If manually adding an animal onto Sam, this should be done before submitting a test (refer to official iSam practice guide). If the data fix is required for an |

|animal that is not registered on the Cattle Tracing System (CTS) or other identifier e.g. Clip mark 1, APHA will require the animal’s date of birth/age, breed and |

|sex. |

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|Animal ID |Date of Birth |Breed |Sex |

|      |      |      |      |

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|      |      |      |      |

|      |      |      |      |

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|If an APHA test has been incorrectly submitted as a private test type, e.g. pre-movement test (PRMT), the practice will need to submit the test correctly using the |

|original WSA, and request the incorrect test to be removed. |

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|If a test has been submitted with the incorrect date, but is required for pre-movement purposes (a valid test certificate is required) the practice will need to |

|re-submit the test and request the incorrect one to be removed. |

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|Additional Comments |

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|Test Performer* (tick relevant box) |Approved Tuberculin Tester (ATT) | |OV | | |

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|Test Performer name in |      |

|BLOCK LETTERS* | |

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|Test Performer | |ATT/OV/SP Number* |      |

|Signature* | | | |

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|If the test performer is an ATT, this form must be authorised by an Official Veterinarian |

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|Authorising OV name in |      |OV/SP Number* |      |

|BLOCK LETTERS* | | | |

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|Authorising OV Signature* | |Date* |      |

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|APHA COMPLETION ONLY | | |

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|Details of any follow on actions that have been/or will be carried out: |

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|Signature of the APHA Duty Veterinarian/Admin for any other changes that require amending: |

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|Signature | |SP Number |      |

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|Name in |      |Date |      |

|BLOCK LETTERS | | | |

|DATA PROTECTION |

|For information on how we handle personal data please go to .uk and search Animal and Plant Health Agency Personal Information Charter. |

APHA is an Executive Agency of the Department for Environment, Food and Rural Affairs and also works on behalf of the Scottish Government, Welsh Government and Food Standards Agency to safeguard animal and plant health for the benefit of people, the environment and the economy.

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