BDS - Animal Sample Collection Form - Queensland Government

Approved control body * Enter the name of the approved control body

Please provide the approved control body.

Name of licensed animal * Enter the registered name of the animal

Please provide the name of the licensed animal.

Sample type * Select the type of sample being collected

Please select a sample type.

Track or other place where sample was taken * Specify the exact location where the sample was collected

Please provide the sample collection location.

Date sample was taken * Enter date in DD/MM/YYYY format

Please provide the collection date.

Time sample was taken * Enter time in 12-hour format with AM/PM

Please provide the collection time.

Sample number * Auto-generated sample number or enter barcode

Please provide the sample number.

Race club or control body conducting the test/race meeting/trial Leave blank if not applicable

Race or trial number Enter race/trial number if applicable

Placing of the animal in the race or trial Enter final position (e.g., 1st, 2nd, 3rd)

Name of person collecting the sample * Full name of the sample collector

Please provide the collector's name.

Name of person who sealed the container(s) * Full name of the person who sealed the containers

Please provide the sealer's name.

Name of witness * Full name of the witness present during collection

Please provide the witness's name.

Witness Certification *

Witness confirms information in items 1–5, 6 (if applicable), 8, and 11

Certification Statement:

I confirm that the information provided in the following items is accurate:

Item 1: Approved control body
Item 2: Name of licensed animal
Item 3: Sample type
Item 4: Sample collection location
Item 5: Date and time sample was taken
Item 6: Blood sample confirmation (if applicable)
Item 8: Sample number
Item 11: Name of witness

I certify that the above information is accurate and complete

Witness certification is required.

Witness Full Name (Digital Signature) *

Please provide your full name as signature.

Date of signature *

Please provide the signature date.

Collector Certification *

Collector confirms information in items 1–5, 6 (if applicable), 7, 8, and 9

Certification Statement:

I confirm that the information provided in the following items is accurate:

Item 1: Approved control body
Item 2: Name of licensed animal
Item 3: Sample type
Item 4: Sample collection location
Item 5: Date and time sample was taken
Item 6: Blood sample confirmation (if applicable)
Item 7: Event details
Item 8: Sample number
Item 9: Name of person collecting the sample

I certify that the above information is accurate and complete

Collector certification is required.

Collector Full Name (Digital Signature) *

Please provide your full name as signature.

Date of signature *

Please provide the signature date.

Sealing Person Certification *

Sealing person confirms information in items 1–5, 6 (if applicable), 7, 8, and 10

Certification Statement:

I confirm that the information provided in the following items is accurate:

Item 1: Approved control body
Item 2: Name of licensed animal
Item 3: Sample type
Item 4: Sample collection location
Item 5: Date and time sample was taken
Item 6: Blood sample confirmation (if applicable)
Item 7: Event details
Item 8: Sample number
Item 10: Name of person who sealed the container(s)

I certify that the above information is accurate and complete

Sealing person certification is required.

Sealing Person Full Name (Digital Signature) *

Please provide your full name as signature.

Date of signature *

Please provide the signature date.