VS 6-22C Tuberculin Test Record (Special)

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FORM APPROVED OMB NO. 0579-0084
USDA, APHIS, VS

TUBERCULIN TEST RECORD (Special)
HERD OWNER - LAST NAME

FIRST NAME

INITIAL

REASON FOR CFT OR SCT
HERD
RETEST

6

CFT OR SCT

HERD(RE)
ACCREDIT.

2

TRACING
REG. KILL

7

RETEST OF CFT/SCT SUSPECTS

MILK
ORDINANCE

3

TRACING
REACTORS

8

TRACING
EXPOSED

9

AREA
ROUTE - STREET - ROAD
STATE (Including Zip Code)

POST OFFICE

4

COUNTY

TOWNSHIP

SECTION

HERD NO.

SALE - SHOW
5

ANIMAL NUMBER

IMPORTED

OTHER
AGE BREED SEX
IDENTIFICATION

COMPLETE HERD TEST OF ALL
ELIGIBLE ANIMALS
YES

SUS

NO

NO

REA

1ST
TOTAL

SERIAL NO.

LICENSE NO.

ELK
_____________
OTHER

BISON

LOCATION OF CC TEST

AVIAN

RIGHT SIDE OF NECK

MAMMALIAN

LEFT SIDE OF NECK

BOVINE PPD
(LOWER)

SKIN
THICKNESS

SKIN
THICKNESS

Millimeters

Millimeters

Millimeters

Millimeters

Millimeters

Millimeters

Normal

72 Hours

Increase

Normal

72 Hours

Increase

PREVIOUS
CFT OR SCT
RESPONSE

CLASSIFICATION
(CC TEST)
(N

S

REACTOR
TAG
NUMBER

REMARKS

R)

2
3
4
5
6
7
8
9

10
11
12
13

14
15

VS FORM 6-22C (FEB 99)

3RD

DEER

1

SIGNATURE

IF NO

2ND

KIND OF HERD
CATTLE

TUBERCULIN

NO. OF ELIGIBLE
ANIMALS IN HERD

COMPARATIVE RETEST

CC TEST RESULTS
NEG

OTHER

CFT OR SCT TEST

COMPARATIVE CERVICAL

YES

10

AVIAN PPD
(UPPER)
OFFICIAL
IDENTIFICATION
NUMBER

DATE INJECTED

1

TITLE

(Previous editions are obsolete.)

DATE

COPY DESIGNATIONS

PART 1 - FEDERAL OFFICE
PART 2 - STATE OFFICE
PART 3 - OWNER COPY
PART 4 - REGIONAL EPIDEMIOLOGIST
PART 5 - VETERINARIAN COPY