All test request forms

For our commonly used test request forms, refer to the list below.

Please note we are in the process of updating all our forms to fillable on-screen forms. We have indicated which forms are currently fillable below.

Instructions for using fillable on-screen forms
Please open the relevant form below in Adobe Acrobat Reader DC, complete on-screen, then SAVE AS the pdf to your hard drive. You can then print out the form and send to ESR with your specimen. 

We recommend using the latest version of Adobe Acrobat Reader DC, available as a free download on their website(external link).

Food and export: 

Food Chemistry sample submission form [PDF, 547 KB] (fillable)

Food Forensic investigation request form [PDF, 930 KB] (fillable)

Microbiological analysis of foods form [PDF, 152 KB]

STEC confirmation sample submission form [PDF, 39 KB]

Food export certification (radiation-free authentication) request form [PDF, 504 KB] (fillable)


Environmental microbiology:

Legionella sample request form [PDF, 987 KB] (fillable)


Describe the water supply system [PDF, 529 KB] (fillable)

Checklist for inspecting and maintaining your water supply [PDF, 100 KB] (fillable)

Microbiological analysis of water form [PDF, 122 KB]

Environmental water sample testing form for Legionella, Mycobacterium, Pseudomonas and Heterotrophic Plate Counts (fillable) [PDF, 548 KB]

Health and surveillance:

COVID-19 (novel coronavirus) test request form [PDF, 961 KB] (fillable)

Referral of clinical specimens for microbiological analysis form for use by public health staff [PDF, 518 KB] (fillable)

Influenza surveillance specimen request form [PDF, 547 KB] (fillable)

Non-human single specimen request form [PDF, 526 KB]

Nosocomial Infections Laboratory multiple isolate referral request form [PDF, 530 KB] (fillable)

Staphylococcus aureus [PDF, 625 KB] (From Blood) referral form (fillable)
Instructions [PDF, 91 KB] on how to use the Staphylococcus aureus form

Single human source specimen form [PDF, 894 KB] (fillable)