APHIS/CDC Form 3 Quick Reference Guide: Submitting an Immediate Notification

Related Pages
  1. Log into eFSAP.
  2. On the entity homepage, click Form 3.
  3. Click Create Form 3image icon.
  4. Complete the following required questions in Section Bimage icon of the Form 3:
    1. For questions 1-2 enter the date of the incident and date the entity made immediate notification to FSAP.
    2. For question 4image icon, select from the dropdown list the location where the incident occurred.
      1. If location not listed on dropdown, enter the location in the box below.
    3. Using the dropdown, select the appropriate select agent or toxin for question 5 and the strain designation for question 6.
    4. Select the Recombinant Agent or PPQ Agent box if appropriate; otherwise leave blank.
    5. For questions 7, enter the quantity.
      1. Provide the unit of measure for each agent or toxin (vial/plate/ampoule/mouse, etc.) quantity.
      2. Each strain must be listed separately.
    6. Click the Add Row button. The information will appear below. Repeat questions 5-7image icon for each additional select agent or toxin involved with the incident.
    7. For question 8image icon, select Theft, Loss, and/or Release for this incident. Select all that apply. The corresponding section(s) will appear below.
    8. Complete required questions for immediate notification in Sections C (Release), D (Loss), and/or E (Theft) according to the response for question 8.
    9. Section C (Release):
      1. Complete question 2image icon. If Yes, select the appropriate environment into which the release occurred (e.g. outside primary containment, outside secondary containment, outside the facility, etc.). Select all that apply.
      2. Complete question 4image icon. If Yes, provide the number of individuals/animals/plants exposed for question 4a. and the number of laboratory staff for 4b.
        Note: The number for 4a. should be the total number that includes the number entered for 4b.
      3. Complete question 6. Select all that apply for the medical surveillance and/or treatment provided to individuals involved in the release incident.
    10. Section Dimage icon (Loss):
      1. Complete question 2. If Yes, complete questions 3-5 for the local law enforcement agency contacted.
      2. Complete question 6image icon. If Yes, complete questions 7-8 for the FBI Agent contacted.
      3. Complete question 9image icon. If Yes, complete question 10 with the date recovered and duration of loss.
      4. Complete question 12image icon. If Yes/Unknown at this time, complete Section C.
        Note: Thefts and Losses must be reported even if the select agent or toxin is subsequently recovered or the responsible parties are identified.
    11. Section Eimage icon (Theft):
      1. Complete question 2. If Yes, complete questions 3-5 for the local law enforcement agency contacted.
      2. Complete question 6image icon. If Yes, complete questions 7-8 for the FBI Agent contacted.
      3. Complete question 9image icon. If Yes, provide the date recovered.
      4. Complete question 10image icon. If Yes/Unknown at this time, complete Section C.
    12. Complete Appendix 1image icon.
      1. Provide a brief summary of the incident.
      2. Describe decontamination of equipment, clothing, areas, individuals, etc.
      3. Describe any other hazards posed by the theft, loss, or release.
      4. Describe any other action taken to respond to the theft, loss, or release.
      5. Include the duration of the release for a leak, spill, aerosolization, etc., as applicable to the incident.
        Note:  The form may be edited after the immediate notification submission and before clicking the Initiate Submit button.
    13. Type your name and titleimage icon in the appropriate fields when complete with all appropriate sections of the form. The date will auto-populate.
    14. Click the Immediate Notification button to submit the form as an immediate notification. Clicking the Close button will NOT submit the notification or save the information. Click Save Draft if you want to save your work without submitting the immediate notification. If the notification is submitted, but you want to make edits or add information before submitting the complete Form 3, click Save Update to save as an updated notification.
      Note: A complete Form 3 must be submitted within 7 days from date of the discovery of the incident. Missing information for any required question will not allow submission of the immediate notification and a dialog boximage icon will pop up to indicate that the required questions are not complete.
Page last reviewed: December 4, 2020
Content source: Division of Regulatory Science and Compliance