Rabies Submission Form – Fill Out and Use This PDF

Animal Information

Animal species __________________________________	Breed ___________________________________________
Description: Color________________________________	Size_____________________________________________
Died  Was killed  Date of collection _____________	Did the animal exhibit signs of rabies?	YES 	NO 
Did the domestic animal have a current rabies vaccination? YES 		NO 	N/A 

Owner of suspect animal ___________________________________________________ Phone___________________

Address ________________________________________________________ County __________________________

() of ( ) total specimens submitted

NO EXPOSURE 

Exposed Information		Date of Exposure ____/____/____
	Name, Address and Phone Number	County Where	Type of Exposure			Site of Human
		Exposure Occurred				Exposure
Human 			Bite		Scratch 
Animal 			Other 
Human 			Bite		Scratch 
Animal 			Other 
Human 			Bite		Scratch 
Animal 			Other 
Human 			Bite		Scratch 
Animal 			Other 

Submitting Agency Information

Submitted by ______________________________________________________________________________________

Address ______________________________________________________________ Phone ____________________

Send Report to_____________________________________________________________________________________

Address ______________________________________________________________ Phone ____________________

Brief Description of Exposure/Comments (Please include where the animal was found) ____________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

FLUORESCENT RABIES TEST RESULTS

(for laboratory use only)

Positive  Negative 

Unsatisfactory  ______________________________________ Date _______________

The submitting agency will be notified of a specimen exhibiting positive evidence of rabies by phone as soon as test results are available.

	IL# 482-0798	Printed by Authority of the State of Illinois		IOCI 12-273
		P.O. #5512230	1M 12/11

GUIDELINES FOR SUBMISSION OF RABIES SPECIMENS

Specimen Collection and Removal of Head and Brain

1.Submit only the head of ALL SKUNKS and other suspect animals.

2.Submit only the entire brain from large animals (e.g., cow, horse).

3.It is acceptable to submit the whole carcass from animals weighing less than 2 pounds (e.g., bat).

4.Live animals will not be accepted under any circumstances.

5Isolate and retain the carcasses of rabies suspects until testing is completed and the report is obtained.

6.Head/brain removal should be performed by individuals who are immunized against rabies and trained in the proper precautions to avoid exposure, such as use of personal protection equipment.

7.Clean and disinfect all instruments used for head removal after each use.

8For advice on testing of animals, please contact your local health department (if not available, please call 217-782-2016).

•Healthy domestic animals that have not exposed a person or owned animal will not be tested.

•Animals showing signs and symptoms of rabies should be tested, even if an exposure did not occur.

•Submission of biting or non-biting rodents (squirrels, mice, rats, hamsters, gerbils, etc.) or rabbits is discouraged unless unusual circumstances surround the bite.

•Animals that have bitten either a person or owned animal can be tested. Healthy dogs, cats or ferrets that bite a person or owned animal after being provoked can be confined for 10 days rather than be tested.

•Any bat that may have exposed a person or owned animal should be tested even if a bite is not known to have occurred (e.g., found in a room with an infant or sleeping, intoxicated or otherwise incapacitated person).

•Scratches alone have not been documented to transmit rabies; if wound(s) could have been made by scratches and/or bites, and the animal is otherwise considered a candidate for testing, or if the scratches were made by a bat, submit the animal for testing.

9.Rabies Submission Form: Provide all information requested on the form, if available. Be certain that a complete history accompanies

each specimen submitted (see reverse side). Indicate on the submission form if more than one animal is submitted. Mark individual specimens with the same identification (e.g., #3 of 5 total animals submitted).

Packaging and Transportation

	1.	Place the specimen in a primary container such as a sealed plastic bag. Bats and other small animals must be placed inside a clear
		zip-lock bag or equivalent. Place the primary container in a watertight secondary container with sufficient absorbent material to assure
		complete absorption if leakage should occur. If plastic bags are used, please TRIPLE bag each specimen. Place the test requisition on
		the outside of the secondary container. Package forms so that they remain clean.
	2.	Place the secondary container inside a rigid outer container with sufficient cold packs to maintain refrigeration temperatures. The minimum
		volume of cold packs surrounding the specimen is double the size of the specimen (never use ice cubes).
	3.	Ample insulation surrounding the specimen and cold packs is essential (e.g., styrofoam packing material or newspaper).
	4.	Do not freeze specimens unless the specimen is held over a long weekend (weekend + holiday) or if the animal is decomposed.
		Cold, not frozen is the general rule. Do not package rabies specimens with dry ice since dry ice may freeze the specimens.
	5.	Pack rabies specimens separately from other types of laboratory specimens (even if they are going to the same lab).
	6.	Messenger/Courier by ground transport Place the secondary container and test requisition in the shipping container. The shipping
		container must be rigid such as a cooler and labeled with the UN 3373 Biological Substance Category B marking. Close securely.
		Styrofoam coolers must be placed in a cardboard box.
	7.	Commercial carrier by ground/air transport Place the secondary container and test requisition in the shipping container.
		Label the outer shipping container with the appropriate Illinois Department of Public Health laboratory address. Complete the return
		address section to include the name of the person shipping the package, business name and address and a business phone
		number. The shipping container must include the UN3373 Biological Substance Category B marking.
	8.	Do not ship specimens on Fridays or the day before a
			You as the shipper, not the transport company, are responsible for
		state holiday unless prior approval is obtained through
		the IDPH Communicable Disease control section. Do not	the shipment until the package reaches its destination.
		ship on Thursdays unless sent by guaranteed, overnight
		delivery. Specimens held by a commercial carrier over a weekend are frequently received in various stages of decomposition that may
		preclude the possibility of reliable test results. In case of emergency, please notify the appropriate laboratory during working hours,
		8:30 a.m. to 4 p.m, Monday through Friday. For an after-hours emergency, notify IEMA at 800-782-7860. Ask to speak with the Illinois
		Department of Public Health Duty Officer.

9.Send specimens by the most expeditious means available, preferably by direct messenger. However, if a commercial carrier is used, the shipper is responsible for conforming to any special packaging requirements of the carrier.

10.The IDPH has no pickup and delivery service and assumes no responsibility for any specimen until it is received and identified.

ILLINOIS DEPARTMENT OF PUBLIC HEALTH LABORATORIES

Carbondale Laboratory	Chicago Laboratory	Springfield Laboratory
1155 S. Oakland St.	2121 W. Taylor St.	825 N. Rutledge St.
Carbondale, IL 62902-2797	Chicago, IL 60612	Springfield, IL 62794-9435
618-457-5131	312-793-4746	217-782-6562

Animal testing other than for rabies is not performed by the Illinois Department of Public Health laboratories.

ILLINOIS DEPARTMENT OF AGRICULTURE LABORATORIES

Animal Disease Laboratory	Animal Disease Laboratory
9732 Shattuc Road	2100 S. Lake Storey Road
Centralia, IL 62801	Galesburg, IL 61401
618-532-6701	309-344-2451

(A fee will be charged for rabies examinations performed by the Department of Agriculture; fee is doubled for emergency procedure)