Scottish Government
Welsh Government /
Sam Data Fix Request
All fields marked with *are mandatory. If an incomplete form is received it may be returned without action.
Customer Name* / APHA COMPLETION ONLY
Customer ID
CPH/CPHH* / Work Schedule ID
WSA ID
WSA ID*
Customer Address
Postcode:
Test Performer * / Delivery Partner (if applicable)
OV Practice inc. postcode *
Postcode:
Email Address / Contact * Phone No. We may need to speak to you about this issue. / Name:
Phone:
Details of error/data to be amended on the Sam customer record:
-Provide details of relevant test dateandtest type (e.g. WHT, SI,TR, also test part P1, P2 etc) – if submitted incorrectly, please provide correct details.State whether the test is clear or contains Rs/IRs
-If you are requesting a change to the status of an animal from tested to non-tested, please confirm the non-test reason to be applied.
-If you are requesting a change to the status of an animal from non-tested to tested, please confirm if flat clear or otherwise please provide the readings and descriptions to be applied.
The Test Performer must sign this form:
Was the Test Performer * / an OV/APHA VO/APHA Tech (delete as applicable)
Test Performer Signature * / OV/SP Number
Name in / Date *
BLOCK LETTERS *
APHA COMPLETION ONLY
Details of any follow on actions that have been/or will be carried out:
Signature of the APHA Duty VO/Admin for any other changes that require amending:
Signature / SP Number
Name in
BLOCK LETTERS / Date
FAIR PROCESSING NOTICE
Defra, the Scottish Government, the Welsh Government and the Food Standards Agency are Data Controllers in Common in respect of personal data processed by the Animal and Plant Health Agency (APHA). For the purposes and usage of the data by APHA and the data sharing arrangements, please see the APHA Personal Information Charter on GOV.UK. A hard copy of this can be provided if required; please contact your local APHA Field Service office. APHA will not permit any unwarranted breach of confidentiality or act in contravention of their obligations under the Data Protection Act 1998. APHA is an Executive Agency of the Department for Environment, Food and Rural Affairs and also works on behalf of the Scottish Government, Welsh Government and Food Standards Agency.
APHA is an Executive Agency of the Department for Environment, Food and Rural Affairs and also works on behalf of the Scottish Government, Welsh Government and Food Standards Agency to safeguard animal and plant health for the benefit of people, the environment and the economy.
GEN02 (Rev. 01/17) OFFICIAL-SENSITIVE