Company developed sample submission forms must include the elements outlined in the following form and be approved by the CFIA during the evaluation audit. This form is a template, and contains the following information fields:
Tracking number, which is used by the company to track their samples using their own system. (1)
CGSP facility identification number. (2)
Name and or contact information for sampling company. (3)
Name and or contact information for the facility where the sample was taken if different than (1) above (4).
Name and or contact information for exporter. (5)
Commodity the sample represents. (6)
Origin of the product (7)
Listing of railcars, containers, trucks, or lot numbers sampled, with instructions to attach an additional sheet with this information if required. (8)
A field requiring a description and quantities of material to be exported, including bag numbers, bag weights and total weight, or tote sizes, tote numbers and total weight, or bulk tonnages. (9)
A field requiring a yes or no answer on whether the shipment or sample was treated with a seed treatment or fumigant. (10)
A field requiring details of the treatment identifed in (10) above. (11)
An information block advising the person submitting the sample that an MSDS should be included for treated product including a gas free certificate if the product was fumigated. (12)
Destination country (13)
Expected date of export (14)
Has the exporter contacted the CFIA to determine the testing requirements for this product going to the destination country?: yes or no. (15)
An information field is provided where the sample submitter is to identify if the sample is to tested for: insects/soil, weed seeds, nematodes or plant pathogens. (16)
An information block advising the sample submitter that the minimum sample size to be submitted is 1 kg, however additional tests may require that larger sample sizes be submitted. They are advised to confirm the sample size requirements before taking the samples. (17)
Sampler's name, signature, telephone and date. (18)