Form VS 5-19C VS 5-19C Scrapie PEMMP Inspection Report

According to the Paperwork Reduction Act of 1995, no persons are required to re spond to a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0579 0084 and 0579-0101. The time required to complete this information collection
is estimated to average .17 hours per response, including the time for reviewin g instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information.

FORM APPROVED
OMB NO.
0579-0101

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
SCRAPIE PEMMP INSPECTION REPORT
Flock ID

Owner Name and Address

Type of PEMMP Plan
____________ Basic
____________ Trace-Retained QQ Ewes
____________ Infected/Source-Retained QR and RR Ewes
____________ Infected/Source-Retained QQ Ewes

Telephone

Inspector

Type of Flock
___________
___________
___________
___________

Inspector ID

Inspection Date

PEMMP Start Date

SHEEP

GOATS

INVENTORY
Adult Males
Adult Females
Yearling Males
Yearling Females
Female Lambs/Kids
Male/Lambs/Kids
Castrated Males
Total

Purebred
Commercial
Feeder
Other

Veterinary Practitioner Name

Predominant Breed
1. YES NO Sheep or goats inspected and found free of Scrapie
2. Clinical signs suggestive of scrapie observed by the producer or inspector
{ } No clinical Signs of Scrapie
{ } Excitable
{ } Incoordination
{ } Abortions
{ } Weight Loss
{ } Convulsions
{ } Itching/Rubbing
{ } Skin Abrasions from Rubbing
{ } Involuntary Muscle Tremors
{ } Nibbling and Licking Movements
3. YES NO NA Animals in the flock exhibiting signs of scrapie are immediately reported to a State
representative, APHIS representative, or an accredited veterinarian.
4. YES NO Sexually intact animals officially identified when sold or they leave the premises
5. Written or computer records kept
YES NO Identification Type of Official ID used ________________
YES NO Sales Information - ID, buyer, date sold
YES NO Purchase Information - ID, buyer, date purchased
YES NO Deaths - Date, Cause of Death
6. YES NO NA Exposed QR or RR ewes that were not removed or redesignated as part of the flock plan
are retained until they die or are slaughtered or euthanized and to submit tissues from
these sheep for official testing as directed by APHIS or the State.
___________ Number of Exposed Ewes remaining in flock

7. YES NO Are Sire Rams Genotypes - Number RR____________; QR____________; QQ______________; Unknown________________
8. YES NO Discussed notification and testing plan for testing some animals that die at over 14 months of age.
9. YES NO NA Animals designated for testing are retained until they have been third eyelid tested or until
they die or are euthanized and had tissues submitted for official testing.
10. YES NO Exposed Ewes with QQ Genotype Retained in Flock (If YES, go to 12)
11. COMMENTS:

Flock Owner Signature

VS FORM 5-19C
(NOV 2005)

Inspector Signature

USDA, APHIS, VS

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****ALL FLOCKS RETAINING EXPOSED QQ SHEEP****
12. Additional Record Keeping Requirements
YES NO Sex and Breed
YES NO Date of Birth
YES NO Animal Sire and Dam Information
13. YES NO All animals officially identified within the flock before they reach one year of age.
14. YES NO Retains all genetically susceptible exposed ewes that were not removed as part of the Flock plan or that are later added to the susceptible flo ck until they die, are
slaughtered or are euthanized and to submit tissues from these sheep for official testing.

****TRACE FLOCKS RETAINING EXPOSED QQ SHEEP****
15. __________ Number of Exposed QQ sheep remaining in the flock
16. YES NO NA Genetically susceptible animals that were born after the high-risk animal lambed are not sold other than direct to slaughter unless they are third eyelid test
negative at over 14 months of age. (The offspring of an RR ram, when only RR rams are present on the premises meet this requirement).

****PREVIOUSLY INFECTED/SOURCE FLOCKS RETAINING EXPOSED QQ SHEEP****
17. ___________ Number of Exposed QQ sheep remaining in the flock
18. YES NO NA Sexually intact female sheep that are of unknown or QQ genotype and female goats are only removed from the premises by permit for slaughter, destruction,
or research. (Offspring of an RR* ram, when on RR rams are present on the premises are considered R? sheep if they have not been genotype.)
19. YES NO No female goats have been added to the flock by purchase or natural addition until all genetically susceptible exposed ewes have been removed or this plan
completed.
20. YES NO After each lambing, placenta and bedding are disposed of it by burial, incineration, or composting in an area to which animals do not have acces s.
21. YES NO NA Confined lambing facilities are cleaned at the conclusion of the lambing season in accordance with the guidelines published in the Scrapie F lock Certification
Program standards.
22. Genetically susceptible ewes which are retained or are acquired
YES NO NA Are tested at over 14 months of age and prior to lambing by the third eyelid test and found negative. Susceptible sheep added to the flock after completion of
the flock cleanup plan are tested at owner expense.
YES NO NA Are maintained separate and apart from the rest of the flock
YES NO NA Are identified with at least two forms of official ID including the APHIS provided EID
YES NO NA Only RR rams are kept in the separate area where genetically susceptible ewes are maintained; male animals maintained in the area where genetically
susceptible ewes are maintained must be castrated, removed to another premises, or double tested RR before they reach sexual maturity
23. COMMENTS

VS FORM 5-19C
(NOV 2005)

USDA, APHIS, VS

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