Manufacturer's Serial Release Test Report

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Company Name
Canadian Veterinary Biologics Establishment Licence Number
Telephone - Facsimile

Assigned Name:
Trade Name:

CCVB Product File No.:

Production Outline Dated:

Serial or Sub-Serial No.:
Fill Date:
Container Size (doses, mL or units):

Expiration Date:
Number of Containers:
Total Number of Doses or Kits:

Test &
Reference
Date On Test
yyyy-mm-dd
Date Off Test
yyyy-mm-dd
Test
Requirements
Tes Results Code*
*Code: S = Satisfactory
U = Unsatisfactory
I = Inconclusive
N = No Test

(Attention manufacturers: Please add a page break here. This will enable you to send the second page to your distributors or customers, thus sharing the serial disposition with them, while keeping tests and results confidential)

Company Name
Canadian Veterinary Biologics Establishment Licence Number
Telephone - Facsimile

Disposition by Manufacturer:

Serial Number:
Expiration Date:

Eligible for release:
Destroyed:
Other:

Name:
Signature:


Date:

Disposition by Canadian Centre for Veterinary Biologics:

Not to be tested:
Tested, satisfactory:
Tested, unsatisfactory:
Other:

Eligible for release:
Not eligible for release:
Other:

Name:
Signature:

Date:
Date modified: