APHIS/CDC Form 3 Quick Reference Guide

1. Log into eFSAP.
   Note: If there are questions concerning the completion or submission of an APHIS/CDC Form 3, you can use the Discussion Panel on the entity’s homepage before completing and submitting the form.
2. Click Form 3 tab.
3. Click Create Form 3image icon. If previously submitted as an Immediate Notification, locate the report on the list of open reports then click the View button adjacent to the relevant incident to edit.
   Note: 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.
4. Section A will have entity information auto-generated, except for question 7image icon. Select the name of the Principal Investigator (PI) from the dropdown list then click the Add button. Add addition PIs associated with the incident.
5. Complete Section Bimage icon:
   1. Complete questions 1-2 by entering the date and time of the incident and date the entity made immediate notification to FSAP, if not already entered.
   2. For question 3, select the Type of Immediate Notification. Select all that apply.
   3. For question 4, select the location where the incident occurred from the dropdown list.
      1. If the location is not listed on dropdown, enter the location in the box below.
   4. Select the name of the select agent or toxin for question 5 and the strain designation for question 6.
      Note: If the strain is not known, enter “Unknown” for question 6.
   5. For question 7, enter the quantity.
      1. Provide the unit of measure for each agent or toxin (vial/plate/ampoule/mouse, etc.).
      2. Each strain must be listed separately.
   6. Click the Add Row button. The information will appear below. repeat questions 5-7 for each additional select agent or toxin involved with the incident.
   7. For question 8image icon, select the Type of Incident, Theft, Loss, and/or Release. Select all that apply. The corresponding section(s) will appear below.
   8. For question 9image icon, use the dropdown list to select the severity that best fits this incident (consideration may be given to impact, consequences, etc.).
   9. For question 10image icon, select the biosafety level(s) where the incident occurred. Select all that apply. Select ‘Other’ if the biosafety level is not listed or applicable to the space where the incident occurred then enter a description in the box provided.
   10. Complete questions 11-12image icon. If Yes, provide the appropriate APHIS/CDC Form 2 Transfer ID (T-F2-######) or APHIS/CDC Form 4 ID number (CID-F4-######) associated with this incident.

Complete Section C (Release), D (Loss), and/or E (Theft) according to the response to Section B, question 8.

6. Section Cimage icon (Release/Potential Exposure):
   1. For question 1, select the type of release/potential exposure. If ‘Other’ is selected, describe in the box provided.
   2. 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.
   3. For question 3image icon, select the type(s) of PPE worn at the time of the incident. Select all that apply.
      1. Select ‘Other’ if the type of PPE is not listed and describe in the box provided.
      2. If respiratory protection is selected, describe the type in the box provided.
   4. 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. Provide numerical values only (e.g., 1, 3, 10, etc.).
      Note: The number for 4a. should be the total number that includes the number entered for 4b.
   5. Complete question 5image icon. If not known at the time of the incident, select ‘not currently known.’
   6. Complete question 6image icon. Select all that apply for the medical surveillance and/or treatment provided to individuals involved in the release incident. If ‘Other’ is selected, describe the measure in the box provided.
   7. For question 7aimage icon, if Yes, describe the investigation in the box provided, and check the corrective actions taken to lessen recurrences for 7b. Select ‘Other’ if the type of corrective action is not listed and describe in the box provided.
7. Section Dimage icon (Loss):
   1. For question 1, select the type of loss. Select ‘Other’ if the type of loss is not listed and describe in the box provided.
   2. Complete question 2. If Yes, complete questions 3-5 for the local law enforcement agency contacted.
   3. Complete question 6image icon. If Yes, complete questions 7-8 for the FBI Agent contacted.
   4. Complete question 9image icon. If Yes, complete question 10 with the date recovered and duration of loss.
   5. For question 11image icon, enter the date of the last inventory/audit performed.
   6. Complete question 12image icon. If Yes/Unknown, complete Section C.
8. Section Eimage icon (Theft):
   1. For question 1, select the type of theft. Select all that apply.
   2. Complete question 2. If Yes, complete questions 3-5 for the local law enforcement agency contacted.
   3. Complete question 6image icon. If Yes, complete questions 7-8 for the FBI Agent contacted.
   4. Complete question 9image icon. If Yes, record the date that the missing select agent or toxin material was recovered.
   5. Complete question 10image icon. If Yes/Unknown, complete Section C.
9. APPENDIX 1image icon (Incident Summary):
   1. Provide a detailed summary of the incident in Appendix 1.
      1. Describe decontamination of equipment, clothing, areas, individuals, etc.
      2. Describe any other hazards posed by the theft, loss or release.
      3. Describe any other action taken to respond to the theft, loss or release.
      4. Include the duration of the release for a leak, spill, aerosolization, etc., as applicable to the incident.
10. Click Initiate Submit to submit the completed Form 3. Clicking Save Update does NOT submit the form. Clicking the Close button will NOT submit the form or save the information.
11. Type your name and titleimage icon in the appropriate fields when complete with all appropriate sections of the form. The date will auto-populate. This functions as the RO or ARO signature.
12. A dialog boximage icon will inform you that the data has been successfully submitted.