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pdfNIST Sample Processing Page 1
National Marine Mammal Tissue Bank Form
Field ID:
Other ID Number:
Genus species:
Common Name:
Collection
Type:
Single Strand
Biopsy
Mass Strand
UME
Repeat Event
Live Capture Release
Rescue
Other (specify):
Condition:
(choose one)
Alive
If euthanized:
Incidental Take
(choose one)
(specifiy):
Fresh Dead (Code 2)
Fisheries
or
Other
Was animal in rehabilitation?
Euthanized
Yes
No
Where:
With what:
If yes:
How much:
From: dd / mm / yy
State:
Bow/Arrow
Gunshot
Subsistence
(choose one)
Other (specify):
To: dd / mm / yy
(please attach cllinical/medical records)
Where:
Animal Location:
Clubbed
County:
City/Island/Community:
Ocean/Bay/Sea:
Locality Details:
N (dec degrees)
Latitude:
Time of death.........
dd / m / yy
hr
Longitude:
Place of Death:
(Zulu)
Internal body temp. of animal:
If transported before tissue removal:
W (dec degrees)
Vehicle Type:
C
F
Rigor?
Yes
No
Length of Transport:
Ambient weather condition:
Remarks:
Time of tissue removal ....
dd / mm / yy
(Zulu)
hr
Place of tissue removal:
Internal body temp. of animal just before tissue removal:
Transportation storage:
If transported before processing:
C
Dry ice
Wet ice
Other:
Teflon bag
Teflon jar
Other:
Ambient weather condition:
Interim storage of tissue:
Remarks:
Time of tissue processing.... dd / mm / yy
hr
(Zulu)
Place of tissue processing:
Ambient temperature at processing:
Time of interim freezing.....
dd / mm / yy
hr
Time shipped to NIST........
dd / mm / yy
hr
dd / mm / yy
hr
(Zulu)
(Zulu)
Time received at NIST.......
Freezer type:
LN 2
-80° C
-20° C
Other:
(Zulu)
Additional comments:
Sample weights:
Blubber (g):
A
B
OMB Control #: 0648-0468
Expiration Date: XX/XX/20XX
Liver (g):
Kidney (g):
Whole
Blood (mL):
Plasma (mL)
Serum (mL):
Other:
F
Animal Information Page 2
National Marine Mammal Tissue Bank Form
Genus species:
Field ID:
Female
Sex:
Male
Unknown
Age Class:
(choose one)
Total length:
cm
in
Actual
Estimated
Total weight:
kg
lb
Actual
Estimated
Age:
Adult
Subadult
Actual
Pup/calf
Yearling
Estimated
Method Used:
(choose one)
Unknown
Epiphysis:
Open
Closed fused
Photo
Testis/Ovaries:
cm
Fetus length:
Bone
Ear Plugs
(Please attach copy of photo or slide)
Mid-Width:
Mid-depth:
Left:
(circle one)
Lactating
Baleen
Other:
Slide
Length:
Pregnant
Teeth (GLG's)
Disposition of specimen:
Fused invis
Reproductive condition:
Sexually Mature
Date aged: dd /mm / yy
By whom:
Right:
Corpora lutea #:
Corpora albicantia #:
Weight:
cm
g
in
oz
Corpora hemmorghagicum #:
in
Specify Units of Measurement:
cm
in
Cetaceans:
Snout to ant. ins. of flipper:
Girth:
Axillary:
Snout to center of genital aperture:
Max:
Snout to center of anus:
Anal:
Flipper length:
(Location)
Thoracic:
Blubber thickness:
Fluke width:
Dorsal:
Fluke notch to anus:
Lateral:
Tooth counts: ..............
UL/LL:
Ventral:
UR/LR:
Pinnipeds:
Nose to tail length:
Ant. length of hind flipper:
Ant. length of foreflipper:
Blubber thickness over post. end of sternum:
Axillary girth:
Other blubber thickness:
(Location)
Bacculum length:
Polar Bears:
Girth of neck of axis:
Skull length:
Girth of neck at shoulders:
Sea Otters:
Snout to angle of mouth:
Right forepaw width:
Skull length:
Skull width:
Axillary girth:
Tooth Wear:
None: Little:
Estimate of body fat stores:
Subcutaneous:
Groin:
Kidneys:
Mesenteric:
OMB Control #: 0648-0468
Expiration Date: XX/XX/20XX
Heavy
cm
Medium
Average:
Light
Excessive:
None
Additional Samples List Page 3
National Marine Mammal Tissue Bank
Field ID Number:
Genus species:
Was animal necropsied?
Yes
No
dd / mm / yy
Necropsied by:
(Please attach necropsy report)
Date
Samples collected:
Histological samples:
Individual/Organization:
Final destination:
Tissues sampled:
Liver
Kidney
Blubber
Stomach
Heart
Intestine
(Choose all
that apply)
Lung
Pancreas
Adrenals
Brain
Muscle
Skin
Trachea
Spleen
Thymus
Colon
Thyroid
Esophagus
Other:
(Please list)
Lymph Nodes:
Submandibular
Prescapular
Axillary
Hilar
Mesenteric
Other l.n.:
Other samples collected:
Type of storage:
(Z-frozen, F-formalin, DMSO, ETOH)
Teeth:
Genetics (skin):
Skull:
Reproductive tract:
Mammary tissue:
Ovaries:
Gonads/testes:
Parasites:
Number of parasites: ...........
List type and location: ...........
Stomach:
List contents if applicable: .......
Other contaminant samples:
(List tissue type, storage
type and where located)
Additional samples:
(List tissue type, purpose of
collection, storage type and
where located)
OMB Control #: 0648-0468
Expiration Date: XX/XX/20XX
0-20
21-100
101+
Where located (Ind./Org.):
National Marine Mammal Tissue Bank
Field ID Number:
General Notes Page 4
Genus species:
Photos taken of animal:
Yes
No
Video taken of animal:
Yes
No
Digital
Film
If yes, how many?
(Please send copy with samples for NIST archive)
Disposition:
(primary location
for photos and/or
video)
General comments:
(Field notes)
General appearance of individual:
General appearance of organs:
NMMTB Protocol:
Standard
Modified
Please note any modifications:
A copy of this form and Level A Data Form
should be shipped with samples to:
Form prepared by:
Name (Print)
Affiliation (Print)
OMB Control #: 0648-0468
Expiration Date: XX/XX/20XX
ATTN: Rebecca Pugh or Amanda Moors
NIST Biorepository
Hollings Marine Laboratory
331 Fort Johnson Rd
Charleston, SC 29412
843-460-9864 / 843-460-9814
National Marine Mammal Tissue Bank
Chain of Custody Page 5
NMMTB's Chain of Custody
Field ID Number:
Other ID Number:
NMMTB Storage ID Numbers:
dd / mm / yy
1.
Collector's signature
Method of transfer to processing stage
Date
dd / mm / yy
2.
Processor's signature
Method of transfer to shipping stage
Shipper to NMMTB's signature
Method of transfer to NIST Biorepository
Date
dd / mm / yy
3.
Date
dd / mm / yy
4.
Receiver's signature
Date
Each person in possession of the tissue must sign and date the form.
PAPERWORK REDUCTION ACT INFORMATION
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply
with an information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently valid
OMB Control Number. The approved OMB Control Number for this information collection is 0648-0468. Without this approval, we could not conduct this
survey/information collection. Public reporting for this information collection is estimated to be approximately 45 minutes per response, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information
collection. All responses to this information collection are mandatory. Send comments regarding this burden estimate or any other aspect of this
information collection, including suggestions for reducing this burden to the National Marine Fisheries Service at: 1315 East West Highway, 13th Floor,
Silver Spring, MD 20910, Attn: Sarah Wilkin, Coordinator, Marine Mammal Health and Stranding Response Program,
sarah.wilkin@noaa.gov if desired.
OMB Control #: 0648-0468
Expiration Date: XX/XX/20XX
File Type | application/pdf |
File Title | Page 1 - Jan 2007 |
Author | rebecca.pugh |
File Modified | 2021-03-31 |
File Created | 2020-12-07 |