VS 5-19 A Flock Inspection and Epidemnity Report Initial Flock Ins

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 0101. The time required to complete this information collection is estimated t o
average 2 hours per response, including the time for reviewing instructions, se arching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information.

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

Flock Name and Address

FORM APPROVED
OMB NO. 0579-0101

Flock Inspection and Epidemiology Report
Initial Flock Inspection for Complete Monitored Status
in the Scrapie Flock Certification Program
Flock Location if Different

Telephone
Inspector

Inspector ID

County

Inspection Date

Latitude

Longitude

Type of Flock
___________
___________
___________
___________

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

Species

Predominant Breed

INSPECTION CHECKLIST
YES

NO

Sheep and goats inspected and found free of clinical signs of scrapie?

YES

NO

Sheep and goats inspected and those over 1 year of age are officially identified?

YES

NO

Discussed procedure for reporting of scrapie suspect animals and the submission of samples?

YES

NO

Official and Secondary Identification

YES

NO

Sex

YES

NO

Breed

YES

NO

Copy of Flock Inventory Attached

YES

NO

Date of Birth for future natural additions to the flock

YES

NO

Site and Dams official and secondary identification for future natural addition s

YES

NO

Progeny Official and secondary identification and Sex

YES

NO

Flock of Origin (Including SFCP status) and date of acquisition for purchased a nimals

YES

NO

Animal deaths-date died and cause of death

YES

NO

Purpose, reason, date and buyer name and address for animals which are sold

YES

NO

Records of .

YES

NO

Commingling of sheep with another producers sheep.

YES

NO

Purchase of ewes from another producer?

YES

NO

Purchase of rams from another producer?

YES

NO

Use of semen and embryos.

Written or computer records reviewed and contain the flollowing information?
Type of official ID______________________________________

Does the producer understand the following records will need to be kept in the future?

Does the owner anticipate any of the following activities to occur over the next year, If so discuss the implications of the activities on their flock status

Comments

Flock Owner Signature

Inspector Signature

VS FORM 5-19A
(MAR 2006)

YES NO

Application Form Completed (VS Form 5-22)

YES NO

Received Copy of SFCP Standards

YES NO

Meets Program Standards