VS 5-19 b Flock Inspection and Epidemiology Report Flock Inspectio

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 1 hour per response, including the time for reviewing instructions, sea rching 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

FORM APPROVED
OMB NO.
0579-0101

FLOCK INSPECTION AND EPIDEMIOLOGY REPORT
FLOCK INSPECTION FOR COMPLETE MONITORED
STATUS
IN THE SCRAPIE FLOCK CERTIFICATION PROGRAM

Owner Name and Address

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
YES

Predominant Breed

INSPECTION CHECKLIST

NO

Sheep and goats inspected and found free of clinical signs of scrapie?
Sheep and goats inspected and those over 1 year of age are officially identified?
Discussed procedure for reporting of scrapie suspect animals and the submission of samples?
WRITTEN OR COMPUTER RECORDS REVIEWED AND TRACK THE FOLLOWING INFORMATION?
Official and Secondary identification Type of official ID _____________________________
Sex and Breed
Progeny Official and Secondary Identification and Sex
Date of Birth or Acquisition
Flock of Origin for purchased animals
Sire and Dams official and secondary identification
Source of animals added since last inspection
Purchased additions-date, name and address of previous owner, status in SFCP
Disposition of removed animals-died-date, cause, any practitioner disgnosis if done
Purpose, reason, date and buyer name and address for animals which are sold
Records of File Typeapplication/pdfFile TitleInForms - vs5-19b.wpfAuthorkhbrownFile Modified2007-10-29File Created2007-10-29