Sample Submission Form (PDF KB) - Defra

Plant Clinic sample submission form
Your Details
Name: Your Ref:
Company: Purchase
order no:
Address:
Name &
Address for
Invoice
(if different)
Postcode: VAT no:
Tel:
Mobile:
* Fax:
* Email:
Would you like to register for SamTrack? (Our free and secure on-line sample tracking system, giving quick & easy access to your sample information)**
The Sample - To help us with our diagnosis, please try and fill in as much information as possible.
Plant genus, species and variety:
(Or Seed/Plant material/Soil type)
Propagation / planting method
(e.g. seed, cutting etc.):
Are the plants grown outside, under
cover, or is this a stored product?
Which pesticides / herbicides have
been used and when?
The Problem
What symptoms have you
observed?
e.g. leaf spot, dieback, wilt
What do you think the cause might
be?
Distribution of symptoms & part of
plant effected (roots, stems etc)?
When was the problem first seen?
If you would like a specific test from
our Price list please state test here:
Fera Reference:
(For internal use only)
Defra hereby excludes all liability for any claim, loss, demands or damages of any kind whatsoever (whether such claims, loss, demands or damages were foreseeable, known or otherwise) arising out of or in
connection with the preparation of any technical or scientific report, including without limitation, indirect or consequential loss or damage; loss of actual or anticipated profits (including loss of profits on contracts);
loss of revenue; loss of business; loss of opportunity; loss of anticipated savings; loss of goodwill; loss of reputation; loss of damage to or corruption of data; loss of use of money or otherwise, and whether or not
advised of the possibility of such claim, loss demand or damages and whether arising in tort (including negligence), contract or otherwise. This statement does not affect your statutory rights.
*
*
* Tick preferred method of contact
Age of plants or
sowing date:
Bacteria Fungi Pest
Nematode Virus
% of plants
affected
Other Information: e.g. cropping history and types of neighbouring plants, slope, temperature, humidity, irrigation, reporting.
I hereby authorise Fera to carry out diagnostic work on this sample and agree to Fera’s Standard Terms and Conditions. Unsigned forms may
not be processed.
Signed: Date:

Sending your sample for diagnosis
How to select your sample – The sample you send provides the key for diagnosis, so please consider the following:
Try to send a sample that is representative of the problem - we need to see the full range of symptoms.
For diseases, try to include the boundary between healthy and diseased tissue and where possible, include healthy material
for comparison and mark as such.
If symptoms on leaves or shoots show general discoloration or dieback, suggesting possible root damage, then please send
us a whole plant (where possible) and include the roots and surrounding soil.
If you suspect the problem is due to nematodes, please include separate soil samples from both the affected area and the
edge of the affected area.
How to package your sample
Whole plants
Leaves and shoots
Fleshy items
Enclose moist root ball in a plastic bag sealed around the plant stem. Place the whole plant in a
second plastic bag, inflate slightly and seal.
Virus diagnosis: Place in a plastic bag, inflate slightly and seal.
Other / unknown
diagnosis:
Wrap sample in slightly moist absorbent paper, place in a plastic bag, inflate slightly and seal.
For example: fruit, vegetables, tubers (except potatoes), bulbs, corms, etc. Wrap in dry, absorbent
paper, if rotting/breaking down please wrap individually. Place in a plastic bag, inflate slightly and
seal
Invertebrate pests Samples of invertebrate pests (insects, spiders, mites etc.) should be put in a sealed plastic
container.
Potato tubers
Invertebrate diagnosis: Wrap in dry, absorbent paper. Place in a plastic bag, inflate slightly and seal.
Other / unknown
diagnosis:
Wrap in dry, absorbent paper. Do not place in a plastic bag.
Soil samples For nematode analysis. Place about 500g of soil in a strong plastic bag and seal.
Seed samples Securely packaged .
All samples should be put in a strong cardboard box and packed securely with screwed up paper. Include your Sample
Submission Form in a separate bag and seal the box
Send your sample to: Plant Clinic
Fera
Sand Hutton
York
YO41 1LZ
United Kingdom
Ideally, samples should be dispatched by either express courier service or first-class post to arrive at Fera next day. If possible to
avoid sending samples over the weekend or a bank holiday, however if unavoidable mark the outer packaging with ‘Please
refrigerate on arrival’ if necessary.
If you have any queries, contact: Fera Plant Clinic Helpline
Tel: 01904 462324
Fax: 01904 462147
E-mail: plantclinic@fera.gsi.gov.uk
** SamTrack is our free and secure on-line sample tracking system, giving quick & easy access to your sample information. You
can register for SamTrack at http://samtrack.fera.defra.gov.uk/. Once you've registered you will receive a unique username and
password along with instructions on how to use the system.
Using SamTrack gives up-to-the-minute information, 24 hours a day. You can...
Check when we have received your sample(s) and who is dealing with your sample(s).
Check what pests and diseases have been identified, check your report and see a summary of all the samples you've sent
to us.
Access information outside normal working hours.
Defra hereby excludes all liability for any claim, loss, demands or damages of any kind whatsoever (whether such claims, loss, demands or damages were foreseeable, known or otherwise) arising out of or in
connection with the preparation of any technical or scientific report, including without limitation, indirect or consequential loss or damage; loss of actual or anticipated profits (including loss of profits on contracts);
loss of revenue; loss of business; loss of opportunity; loss of anticipated savings; loss of goodwill; loss of reputation; loss of damage to or corruption of data; loss of use of money or otherwise, and whether or not
advised of the possibility of such claim, loss demand or damages and whether arising in tort (including negligence), contract or otherwise. This statement does not affect your statutory rights.