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 from the Adobe website.

Food and export: 

Food chemistry sample submission form (fillable)

Food forensic investigation request form (fillable)

Food microbiology analysis sample submission form (fillable)

Food export certification (radiation-free authentication) request form (fillable)

Radiation testing of food form (fillable)

Single specimen request for Meat Enrichment broth (fillable)

Environmental microbiology:

Legionella sample request form


Water microbiology sample submission form (fillable)

Environmental water sample testing form for Legionella, Mycobacterium, Pseudomonas and Heterotrophic Plate Counts (fillable)

Health and surveillance:

Clinical Virology Laboratory (Wallaceville Science Centre) Test Request Form

COVID-19 (novel coronavirus) test request form (fillable)

COVID-19 wasterwater testing collection form

Referral of clinical specimens for microbiological analysis form for use by public health staff (fillable)

Influenza surveillance specimen request form (fillable)

Non-human single specimen request form

Nosocomial Infections Laboratory multiple isolate referral request form (fillable)

Staphylococcus aureus (From Blood) referral form (fillable)
Instructions on how to use the Staphylococcus aureus form

Single human source specimen form (fillable)