CBAT Kit Inventory

CBAT Kit Inventory
The purpose of this inventory is to substantiate the location, contents, and condition of the CBAT kits supplied by the DPHHS Laboratory Services Bureau (LSB). The information you provide will also determine if the kits still contain the proper elements and are not damaged.

It has been several years since these kits were assembled and distributed. The lab has occasionally received reports that some kits have lost their seals, or that items within them were missing, expired, or dried up (pens/Sharpies). Other changes over the years have included the turnover of personnel, so becoming familiar with the contents is prudent.

The custodian of the CBAT kit should be a local or tribal health contact, a DES personnel, a HAZMAT Team member, a jurisdictional sanitarian or environmental health officer, a member of the 83rd Civil Support Team of the MT National Guard, or a member of the MalmStrom Air Force Base 341st Emergency Management Flight. In some cases, a hospital clinical laboratory or public water works may be identified as a repository of the kit. The responsible individual assigned to the kit would qualify as "other".

lf your jurisdiction has more than one CBAT Kit, please fill out one form for each CBAT kit.

DO NOT RESEAL the Kit until you have all the needed supplies to fill it.
Please complete the following information for the person completing this form and the jurisdiction you represent.
Name *

First NameLast Name
Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Jurisdiction (County/Tribe)
Please Select
Is the person completing this inventory responsible for knowing where the kit is located in an emergency?
CBAT user

YesNo
Is the person completing this inventory form from the local or tribal public health department?
CBAT user PH

YesNo
Is the person completing this inventory a regional HAZMAT team member, a DES member, a member of the 83rd Civil Support Team of the MT National Guard, or a member of the Malmstrom Air Force 341st Emergency Management Flight?
CBAT user HAZMAT

YesNo
Please check this box and then indicate your position and affiliation if you did not fit the above categories.
Other CBAT inventory*

Not a member of Public Health or regional HAZMAT
Are you the Primary or Secondary PHEP person for your jurisdiction?
PHEP level*

PrimarySecondaryNeither
Please provide the name and email of the jurisdiction's Primary PHEP contact.
PHEP Contact*

First NameLast Name
PHEP Contact email*
example@example.com
Did you locate your jurisdiction's CBAT kit?
CBAT Found?*

YesNo
Kit Tracking Number
Kit Location
PLEASE CONTACT KIM NEWMAN AT knewman@mt.gov OR 406-444-3068 FOR ASSISTANCE.
Examination of the CBAT Kit
Is the tamper-resistent seal on the CBAT kit unbroken?
Intact Seal?*

YesNo
Please rate the condition of the CBAT kit exterior.

*You can break the seal of to conduct this inventory! The LSB will provide replacement evidence seal tape.
Kit Exterior Condition*

Poor - Dents, cuts, holes, etc.Fair - Some deeper scratches, scuff marks, maybe a gouge or twoGood - No damage, but might be showing its age, minor scratchesExcellent - Damage-free and is clean
Complete each inventory section: Check off each box if the item is present and intact.

If an item is missing, expired, or damanged, please describe it in the comment box below each section. (Example: Missing one sterile spatula).
Outer Container - Check all the apply
Outer Container*

Lid intact and securely fastenedPhone number presentHandle present and functional
Comments regarding the Outer Container:
Inner Contents: Cold Zone Pack (one each) - Check all the apply
Cold Zone Pack*

One Cold Zone zip lock bag: clean, intact, and zip-seal intactOne Sampling Protocol: present, clean, and legibleTwo (three copy) Unknown Sample /Chain of Custody forms: clean, untorn, and legibleOne 7-inch length of tamper-resistant evidence tape: clean and NOT separated from backingOne ball-point pen
Comments regarding the Cold Zone Pack:
Inner Contents: Warm Zone Packs (two each) - Check all the apply
Warm Zone Pack*

First Warm Zone Pack - One Warm Zone zip lock bag: clean, intact, and zip-seal intactFirst Warm Zone Pack - One plastic, overpack jar with screw-cap lid and absorbent pad: unopened, clean and dryFirst Warm Zone Pack - Two 7-inch lenghts of tamper-resistant evidence tape: clean and NOT separated from backingFirst Warm Zone Pack - One Permanent marker (Sharpie)Second Warm Zone Pack -One Warm Zone zip lock bag: clean, intact, and zip-seal intactSecond Warm Zone Pack - One plastic, overpack jar with screw-cap lid and absorbent pad: unopened, clean, and drySecond Warm Zone Pack - Two 7-inch lengths of tamper-resistant evidence tape: clean and NOT separated from backingSecond Warm Zone Pack - One Permanent marker (Sharpie)
Comments regarding the Warm Zone Packs:
Inner contents: Hot Zone Packs (two each) - Check all the apply
Hot Zone Pack*

First Hot Zone Pack - One Hot Zone zip lock bag: clean, intact, and zip-seal intactFirst Hot Zone Pack - One sterile, unopened pack containing a wide-mouth, glass sample jar that is clean and unopened.First Hot Zone Pack - One unopened pack containing a sterile 50 ml polypropylene conical tube that is clean and unopened.First Hot Zone Pack - One sterile BBL CultureSwab environmental sampling swab: clean, unopened, and unexpired.First Hot Zone Pack - One sterile spatula: clean and unopenedFirst Hot Zone Pack - Two sterile transfer pipets: clean, unopened, and unexpired.Second Hot Zone Pack - One Hot Zone zip lock bag: clean, intact, and zip-seal intactSecond Hot Zone Pack - One sterile, unopened pack containing a wide-mouth, glass sample jar that is clean and unopened.Second Hot Zone Pack - One unopened pack containing a sterile 50 ml polypropylene conical tube that is clean and unopened.Second Hot Zone Pack - One sterile BBL CultureSwab environmental sampling swab: clean, unopened, and unexpired.Second Hot Zone Pack - One sterile spatula: clean and unopenedSecond Hot Zone Pack - Two sterile transfer pipets: clean, unopened, and unexpired.
Sampling swabs and transfer pipets expiration dates: *
Comments regarding the Hot Zone packs:
In 2025, the LSB will provide a new lid gasket, sterile 50 ml conical tubes, new zone Ziploc bags, updated instructions, updated Chain of Custody forms, and new tamper resistant evidence tape in the quarter prior to the inventory. The kit should be resealed at the finish of the inventory process unless other supplies are needed. The LSB will provide replacements for any noted missing supplies based on the inventory. Please DO NOT RESEAL the Kit until all replacement supplies have been placed in the CBAT Kit.

You will receive an email with the information you provided as a receipt of submitting this form. If you are not a PHEP Officer, please forward this email to your jurisdiction's PHEP Officer.
Have you replaced the Kit lid gasket with the new gasket provided?*

YesNo
Have you resealed the CBAT Kit with the evidence tape provided?*

YesNo
Should be Empty:

CBAT Kit Inventory

Examination of the CBAT Kit