NAHMS 165 Poultry '04 Small Production and Backyard Flock Question

Poultry ’04
Animal and
Plant Health
Inspection
Service

Small Production and
Backyard Flock
Questionnaire

Veterinary
Services

State:

Commercial ID Premises Type ID:
(radius drawn around)

National Animal Health
Monitoring System
2150 Centre Ave, #B, MS 2E7
For~ Collins. CO 80526
Form Approved
OMB Number 0579-xxxx
Approval expires: 12/31/06

Date:

1 st celumn of Summary Sheet
- code for this type of unit

DATA COLLECTOR: DON’T FORGET TO ANSWER
A. Is this premises: r3~ a single family home (4 units or:
El2 an apartment?
g]3 a home

of today, how many
A. Chickens: table egg
B. Chickens: meat breeds (for exampIe Cornish,
C. Chickens: game fowl (for example,
D. Chicken: others
E. l’urkeys
F. Ducks: ..............
G.
H. Pigeons or doves .....
I. Ratites
J.
K.
L.

ises?

As

head
head
head
head
head
head
head
head
head
head
z housed in cages
finches, and canaries) ...................

In miles or
your premises to the nearest:
A. feedstore? .................................................................. Feet:
sold? ....................................................... Feet:
B. auctions where
~eets where birds are sold? .........................Feet:
C.
D. Five bird market~ .....................................................Feet:

head
head
total

OR Miles:
OR Miles:
OR Miles:
OR Miles:

3. How many commercial operations are within I mile? ....................................................

:cording to the Paperwork Reduction Act of 1995. no persons are required to respond to a co ection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0579-xxxx. The time
required to comslete this information collection is estimated to average .50 hours per response, including the time to review
instructions search existing data resources, gather the data needed, and complete and review the information collected.

g/cahm/poultty/poutr_O4foackyard fleck questionnaire

|
~

NAHNS-165
April 2004
419104

The remaining questions refer to all other birds EXCEPT pet birds (definition of pet bird in #IL above)
4. Do the birds you keep on your premises have access to:
A. the ground outside? ...................................................................................................r-l~Yes
B. neighboring premises? ..............................................................................................[]rYes

D3 No
l-q3 No

Are any birds you keep on your premises kept in the following housing types?
A. Outdoors, confined to yo~ property (including tethered birds) ........................... Yl,Yes
B. Outdoors, able to leave properg¢. ............................................................................... rl~Yes
C. Inside such as in a barn or coop ...... rq~Yes
If YES,
C1. Are birds turned out to outdoors? ..............[]~Yes []3 No
C2. How are indoor birds housed? .................D,Cages
Do the birds have comacr
A. Owner’s dogs or cats ......
B. Neighbor’s dogs or cats ............
C. Neighbor’s poultry
D. Wild birds
F. Pigs
G. Cattle/sheep/goats ...............................a ..........................
~
)
H. Other animals (specify:

,Yes
[]aYes
[]~Yes

r13 No
No
NO
r~ No
r~3 No
[]~ No
[]_~ No

,Yes

ff]~ No

I--[15
[]1"~

7, Do raccoons, foxes, skunks, or

bird area?./Check one only.)

8. How often do you see rodents (rats and mice) or

area?

Are any of the
A.
B. Traps /
C.
D.

[]rYes
[],Yes
[],Yes

D3 N
~3 N
[]~N

[]~Yes

[]3N

.[]~Yes
) ............................................[]~Yes

[]3N
~~3N

services for any bird(s) for any reason? .........
[],Yes

[D3 No

11. Where do you ~
medication? (If no medications used, check all No./
[]1Yes
A. Mail order or
[~Yes
B. Farm c
D,Yes
C. Make own .........
D~Yes
D. Veterinarian ..............................................................................................................
E. Other suppliers (specify:
) .................................................. D,Yes

r~3 No
D~ No
D3 No
t513 No
D~ No

!0.

g/cahm/poultry/poutr_O4/backyard flock questionnaire

12. Has your flock been vaccinated in the last year forthe fo110wing diseases?
No
Some
All
Birds
Birds
Birds
Vaccinated
Vaccinated
Vaccinated
r-t
I~
[]3
2
A. Newcastle.disease ................................
B. Marek’s disease ...................................
[]2
[]3
C. Laryngotracheitis (LT) ........................r~l
[]2
r~3
D. Pox ...................................................... r-l~
[]~
E. Infectious bronchitis (IBV) ..................
F. Infectious bursal disease CIBD) ...........
[]2
G. Other~ diseases" ......................................[] ~
(specify,other diseases:
In the last year, were any of the following
A. Injectable vitamins...
B. Coccidiosis prevention or rreamaem ....
C. Antibiotics for disease treatment ....
D. Other medications (specify:

sources

[]~
[]4

.... r11Yes

D3 No
1-13 No
[]3 No
[]3 No

............ :
)

14. Did you have any of the following problems in
A. Diarrhea
B. Respiratory (nasaFocular discharge, cough/sneeze,
C. Neurologic (incoordination.
D. Weight loss ........
E. Feed refasaFdepression (droopy birds)
F. Sudden decreased production (egg laying,
G. Unexplained death loss .......
H. Other ~
I5. How important to ’

Don’t know
if any birds
were vaccinated
[]~

........... []
1213 No
smuses)...r11Yes []3 No
[]~Yes []3 No
[]~Yes [].~ No
1Yes [].~ No
Yes [].~ No
[]~Yes []~ No
[] rYes IZl~ No

health information?
Somewhat
Important

Not
Important

A. Veterinarian (private
B.
C.
D.

D~

i-11

[]2

D3

D~

D~

D3

Biosecurity
Which o
,iosecurity precautions for the feet required
for anyone going into the bird area?/Check 1 only)
[]t Boots or shoes dedicated solely for the bird area
Dz Disposable boot or shoe covers
V’13 Use of footbath before or after entry
F14 Scrub boots!shoes bef6re or after entry
D5 No requirements
2. Do you require that dedicated clothing or a change of clotbSng
rq~Yes
be put on before you or anyone else enters the bird area? ..............................................
g/cahm/poultry/poutr_O4/backyard flock questionnaire

3. Do you require that hands be washed:
I~Yes
A. before handling the birds? ........................................................................................
HiYes
B. after handling the birds? ..........................................................................................

VI3 No
H3 No

4. Are visitors such as neighbors, repmrmen,
[]1Yes V13 No
meter readers, allowed in the bird area? ..........................................................................
A. If YES, are visitors asked about contac~ with other birds before allowed in area? .. []lYes
[]3 No

Bird Movement
I

Were fertilized eggs for hatching brought onto the premises in the iast

2_ Ho~y times int~eqast’

kip to #7

If 0 birds int~be~d~~in last

[

~
r~3 No
~Y~s
[]3 No
~iYes Vl~ No
"

3. Did youbring in any of the following age groups of
A..Day-old chicks ...............
B. Young stock .....................
C. Adultbirds .........................

[]~Yes ~ No

Were new birds usually separated
rest of the fleck upon arrival? ......

........ []-12 No other birds present

days

If Yes, how many days do you usually
from:

Did any of the
A. within your
B. outside
C. outside your state
D. outside the U.S ..........

¯,Yes
Vl~Yes
~ .......................................... VllYes
[],Yes

[]3 No
Vl~ No
[]~ No
[]3 No

come ~vith a health certificate? ,~Check l only)

7. Did yet
stock: in th~

stock or sell,

BUYING stock
¯iYes []3 No

sell/give away your stock?
IF YES~ where
. ............................................. []lYes
A. Local
B. Private
neighbor) .................................... H~Yes
C.
[]~Yes
D. Fair or show ............: ..........................................: .............. []~Yes
E. " Live bird market ...............................................................[]iYes
F. Flea or farmer’g market ....................................................
[-I1Yes
G. Auction market .....................................:~ .......................... []~Yes
H. Mail order Or intemet .........................................~ .............. H1Yes
~ ............ []rYes
I. Poultry dealer or wholesaler ................................
J. Other (specify:
) .......... vllYes
g/cahm/poultry/poutr 04/backyard flock questionnaire

SELLING stock
[] iYes ~3 No

//

If birds were soId pr given away in the.Iast year, did any birds go to the foIIowing Iocations?
A. witbAn your county? ..................................................................................................Vl,Yes ~3 No
B. outside your county but within your state? ..........
~ ................. J ............ i .....................Vl~Yes ~3 No
C. outside your state but within the U.S ................................................................
: .......VllYes [23 No
D. outside the U.S ..........................................................................] ...............J .............. VllYeS ~3 No
9. How many times in the last year did you take any of your birds
to a location, for example, fair or show, where other birds were present
and then yon returned your birds ~,o your premises? ...................................
i ................2._

times !ast yr

~, skip to #!2
lO~Ye~e agy~a f_thes~
As within your county?
B. outside your county but within your ~tate? ................................ ~
C. outside your state but within the U.S
D. outside the U.S.
1 t. Were the birds always, sometimes, or neve~ isolated c
re-commingled with other birds on your premises?

’ wei:e ¯

Always isolate V12 Sometimes isolate ~s Neve~

~4 No other birds on premises

12. !n the last 3 months, did yon visit a
feedstore with birds, fair, Or neighbors
If YES, did yon take any of the following bio
A. Change clothes ..............................................
overs? ...........
B.
C. Wash hands ..........
D. Shower ............
E. Take other

your own bird area?
[~ No
......................... ~]~Yes r~3 No
.~Yes EJ3 No
[]~Yes r~3 No
~]3 NO

Disposal
1. Not

how many
head

ktO #3.
2.Which of the fotlo~ the2~/mary method of disposing of the dead birds? rCheck 1 only)
r~5 Compost
Incinerate ~
El6 Taken to a landfill or put in trash
Bury on premise~
Render picked Ul~
~1~ Fed to other animals
Carcass taken to renderer
r~s Other disposal methods (specify:
3. Which of the following best describes how you dispose of used bird litter ~nd manure? gCheck ] only)
~ Place in manure shed/composted
l~s Haul away (sell or g~ve away)
Zlz Leave in an outdoor pile
[36 Other disposal methods (specif):.
¯V33 Spread on field!garden at this locationI"-17 Do not have enough litter/manure to dea! with
r~4 Taken to a landfill or put in trash

g/cahm/poultry!poutr__O4!backyard flock questionnaire

About You
1. On a scale of I to !0 with 1 being not important and 10 being extremely important, how impor~am are the
following reasons to you for why you have birds?
Ex~eme~imponant
Not impormm
12345678
9 10
7
1 2 3 4 5 6
8 9 10
A. Family tradition
1 2 3 4 5 6 7 8 9 10
B. Fun/Hobby
1 2 3 4 5 6 7 8 9 10
C. Income
1 2 3 4 5 6 7 8 9 0
D. Food source
Lifestyle
I 2 3 4 5 6 7 o
E.
F. Social interactions (e.g., 4H, clubs) ! 2 3 4 5 6 7
.G. Ot erherreas~ro Ha v~e-b~rds~
(specify:
)
2. How many years have you or your family raised birds on this
3. Does anyone in this household work for a
commercial poultry production or processing
4. Do you belong t~ any type of poultry or avian association?
5. How many minutes did it take to corn

g/cahm/poultry/poutr_O4/backyard flock questionnaire

years
No