SWI 132.1.1 Seed Program
Specific Work Instruction
Official Seed Sampling

Appendix V: Sample Submission Form (CFIA/ACIA 5160)

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Front view
The following is a sample submission form for pesticides, fertilizers, feeds or seeds.
Sample Submission Form (front view). Description Follows.
Rear view
Sample Submission Form (rear view). Description Follows.
Description for Sample Submission Form

The following is an example of a submission form for pesticides, fertilizer, feed or seed samples. It is used by inspectors to submit samples to the laboratory for testing. The form gathers information such as when the sample was taken, how it was taken, where it is coming from, etc. The form has three main sections: the inspection information i.e., where it was sampled at, the inspection type, etc.; the seed information i.e., its common name, country of origin, etc.; and lastly, the submitter's information that is to say their name, address, etc.

Instructions for Completion of the Sample Submission Form

The Sample Submission Form can be found in Desktop eForms for a reference hard copy (this document is intended for internal use).

The SSF is also found on CFIA Applications - LSTS - Submission Forms - Metaframe (LSTS).

The following instructions apply:

  1. when the sampler makes an error in recording information on the SSF (hard copy), each error must be crossed out (not erased, made illegibly, no whiteout) and the correct information written alongside. All corrections must be initialled and dated. All information must be written in ink;
  2. when sampling for the issuance of an ISTA certificate, the sampler must state on the SSF what method of sealing was used, i.e., stitched OECD label, metal seal;
  3. when the sampler is submitting a sample that is treated, the name of the pest control product must be stated;
  4. when the sampler is submitting a sample that is inoculated, the name of the inoculant product must be stated;
  5. when the sampler is submitting a sample that is coated or has a component that is coated, the percentage of the coating material and the name of any pest control product/inoculant must be stated;
  6. the field in the form "# Units Sampled" must be completed with the number of primary samples taken;
  7. when the trier size or methods for sampling deviate from those stated in this SWI, the reason must be documented on or accompany the SSF;
  8. when the sample submitted is a seed mixture, the sampler must state the name and percentage of each component, when available, comprising the mixture on the SSF. If this information is not available, it should be stated on the form;
  9. when the sampler is submitting a marketplace surveillance sample, the information as described in Section 15.5 must be stated on the SSF or an accompanying document;
  10. when the sampler has mixed and divided the sample, this must be stated on the SSF;
  11. when submitting samples for Plant Health purposes, the sampler must state on the SSF for what species the sample must be examined, or the specifications must be attached to the SSF;
  12. the 'Sampled at' field in the SSF should be the physical location of the seed. The 'Vendor' field must be completed if the 'Sampled at' location is not the vendor;
  13. for marketplace surveillance, the 'Total weight of the lot' means the portion of the lot remaining at the time of sampling and does not include the portions of the lot that have been sold and are no longer remaining;
  14. in cases where the seed lot is in containers of one size, but there is leftover seed at the end of the lot in one partially full container or a smaller container, this container is to be included as part of the lot and treated as the same kind of container for sampling intensity purposes (Section 11.8);
  15. the inspection sample number and the name of the sampler on the SSF must link to the inspector number on the CFIA List of Official Seed Samplers. The SSF should be completed, including the date and signature, by the sampler who conducted the sampling.
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