Company name
Canadian veterinary biologics establishment licence number
Telephone – facsimile
Assigned name:
Trade name:
CCVB file number:
Serial or sub-serial number:
Fill date:
Container size (doses, mL or units):
Outline of Production date:
Expiration date:
Number of containers:
Total number of doses or kits:
| Test and reference |
Date on test yyyy-mm-dd |
Date off test yyyy-mm-dd |
Test requirements |
Test results | Code |
|---|---|---|---|---|---|
Code legend
- S = Satisfactory
- I = Inconclusive
- U = Unsatisfactory
- NT = No test
(Page break may be added here. Include company name, Canadian veterinary biologics establishment licence number, CCVB file number, and serial or sub-serial number in the header information on all subsequent pages)
Company name
Canadian veterinary biologics establishment licence number
Telephone – facsimile
Disposition by manufacturer
CCVB file number:
Serial or sub-serial number:
Expiration date:
Eligible for release:
Destroyed:
Other:
Name, title, signature, and date:
Disposition by Canadian Centre for Veterinary Biologics
Not to be tested:
Tested, satisfactory:
Tested, unsatisfactory:
Other:
Eligible for release:
Not eligible for release:
Other:
Name, title, signature, and date: