Section to be completed by DAFM
                                                                       Date sample received:
                                                                       Sample received by
                             Honey bee Health Surveillance Programme
                                                  Customer Sampling Form
                  Beekeeper Information:
                  Name
                  Address
                  County
                  Eircode
                  Tel
                  Email address
                  *The request, storage and use of this information is compliant with GDPR (see overleaf)
                  Sample Information:
                  Sample ID                 Sample Type                                      Reason for sampling
                  (Hive no./ Apiary no)     (Bees only; Brood only; Bees/Brood; other)       Routine or suspicious
                  Dispatching samples:
                       Samples should be sent in packaging, which is readily disposable, yet rigid enough to prevent
                           the samples from being crushed (for example: a match box in a padded envelope) 
                       The sampling form must be filled out and enclosed with the samples. Do not place the
                           information sheet in direct contact with samples. 
                       If possible, avoid sending samples at the end of the week (after Wednesday) as the samples
                           may be blocked in the post and this can compromise or limit the type of analysis.
           Send samples to:
           Honey bee Health Surveillance Programme
           c/o Dr Mary F Coffey
           Department of Agriculture, Food and the Marine
           Plant Health Laboratories,
           Backweston Laboratory Campus,
           W23 X3PH,
           Ireland.
           *The use of personal data by the Minister
           Data, including personal data submitted under the honeybee health surveillance programme is required to ensure 
           compliance with European Union animal health law. The Minister is the Controller for this personal data under data 
           protection law.  This data   will be used for statistical purposes only and will not be shared with any other agency or national  
           authority.  
           This data is retained by the Minister for these purposes and compatible purposes under the Minister’s data retention policy, 
           after which it is destroyed where permitted under the National Archives Act.
           You have a right to request access to and correction of your data. A right to seek erasure of the data and to object to or seek
           restrictions on its use may apply in certain circumstances. You have the right to lodge a complaint on the use of your data 
           with the Data Protection Commissioner. Queries on the use of personal data should be directed to the Minister’s Data 
           Protection Officer. Further details of your rights under data protection law can be found here.  
           https://www.agriculture.gov.ie/dataprotection/