Form 89-864 Marine Mammal Stranding Report - Level A Data

MARINE MAMMAL REHABILITATION DISPOSITION REPORT
FIELD #: __________________________ NMFS REGIONAL #______________NATIONAL DATABASE#: _________________________________
(NMFS USE)
(NMFS USE)
COMMON NAME: _______________________________ GENUS: _________________________ SPECIES: _______________________________
REHABILITATION FACILTY: ________________________________________ Affiliation: ______________________________________________
Address: ______________________________________________________ Phone:___________________________________________________

STRANDING/BIRTH HISTORY
□ Restrand
Date: Year: _____ Month:______ Day: ______
Location: State: _______ County: __________ City: ___________
Sex:
□ 1. Male
□ 2. Female
Was this animal born in rehab?
□ 1. NO □ 2. YES; Female’s ID #: ________________________

ADMISSION INTO REHABILITATION
Date: Year: ________ Month:_________ Day: _________
Received From: _________________________________
Straight Length:___________ □ cm □ in □ actual □ estimate
Weight:_________________ □ kg □ lb □ actual □ estimate

MEDICAL RECORD

SPECIMEN TRACKING

Pre-Release Health Screen Date:
Year:______ Month:______ Day:______

Samples Collected:
□ 1. YES □ 2. NO
□ 1. Scientific collection
□ 2. Education collection
□ 3. Other: _________________________________________________

Last Day of Antibiotics: Year:______ Month:______ Day:______
MORPHOLOGICAL DATA AT DISPOSITION
Animal Morphological Data at Time of Disposition:
Straight Length:_____________ □ cm □ in □ actual □ estimate
Weight:___________________ □ kg □ lb □ actual □ estimate
FINAL DISPOSITION
□ Releasable
□ Non-releasable

Age Class at Time of Disposition:
□ 1. Adult
□ 3.Yearling
□ 2. Subadult
□ 4. Pup/Calf

□ 5. Unknown

□ Not Applicable

□ 1. Transferred to Another Rehabilitation Facility
Year: __________ Month:_______ Day: ________
Facility:_______________________________________________
Address:______________________________________________
Comments:____________________________________________
_____________________________________________________
□ 2. Temporarily Transferred to Research Facility
Year: __________ Month:_______ Day: ________
Facility:_______________________________________________
Comments:____________________________________________
NMFS Permit #: ________________________________________
□ 3. Permanently Transferred for Research/Enhancement
Year: __________ Month:_______ Day: ________
Facility:______________________________________________
Comments:___________________________________________
NMFS Permit#: ______________NOAA ID #: ________________
□ 4. Permanently Transferred for Public Display
Year: __________ Month:_______ Day: ________
Facility:______________________________________________
Comments:___________________________________________
NOAA ID #: __________________________________________
□ 5. Died
□ Euthanized
Year: ________ Month:_______ Day: ________
Location:_____________________________________________
Cause of Death: ______________________________________
Comments:___________________________________________
NECROPSIED □ NO □ YES
□ Limited □ Complete
□ Carcass Fresh □ Carcass Frozen Thawed

□ 6. Released
Year: ________ Month:_______ Day: ________
State: ______ County:__________ City:__________________________
Locality Details:_____________________________________________
Latitude (DD):_____________________________________________ N
Longitude(DD):____________________________________________W
Released: □ Singly
□ With Other Rehabilitated Animals
TAG DATA
Tags Were:
Present at time of stranding (Pre-existing):
Applied during Stranding Response:
Applied During Rehabilitation:
ID#

Color

Type

Placement*
(Circle ONE)
D DF L
_________________________ LF LR RF RR
D DF L
_________________________ LF LR RF RR
D DF L
_________________________ LF LR RF RR

□ YES
□ YES
□ YES
Applied

□ NO
□ NO
□ NO
Present

□

□

□

□

□

□

* D= Dorsal; DF= Dorsal Fin; L= Lateral Body
LF= Left Front; LR= Left Rear; RF= Right Front; RR= Right Rear

Post Release Biomonitoring

□ YES

□ NO

Data Disposition:
_______________________________________________

NECROPSIED BY: _______________________ Date _____________

NOAA Form 89-878 (rev. 2007); OMB Control No. 0648-0178; Expiration Date: 10/31/2010

PLEASE USE THE BACK SIDE OF THIS FORM FOR ADDITIONAL REMARKS

ADDITIONAL REMARKS
ADDITIONAL IDENTIFIER:
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DISCLAIMER
THESE DATA SHOULD NOT BE USED OUT OF CONTEXT OR WITHOUT VERIFICATION. THIS SHOULD BE STRICTLY ENFORCED WHEN
REPORTING SIGNS OF HUMAN INTERACTION DATA.
DATA ACCESS FOR MARINE MAMMAL REHABILITATION DISPOSITION DATA
UPON WRITTEN REQUEST, CERTAIN FIELDS OF THE MARINE MAMMAL REAHBILITATION DISPOSITION DATA SHEET WILL BE RELEASED TO THE REQUESTOR PROVIDED THAT THE REQUESTOR CREDIT THE STRANDING NETWORK AND THE NATIONAL MARINE
FISHERIES SERVICE. THE NATIONAL MARINE FISHERIES SERVICE WILL NOTIFY THE CONTRIBUTING STRANDING NETWORK MEMBERS THAT THESE DATA HAVE BEEN REQUESTED AND THE INTENT OF USE. ALL OTHER DATA WILL BE RELEASED TO THE REQUESTOR PROVIDED THAT THE REQUESTOR OBTAIN PERMISSION FROM THE CONTRIBUTING STRANDING NETWORK AND THE NATIONAL MARINE FISHERIES SERVICE.
PAPERWORK REDUCTION ACT INFORMATION

PUBLIC REPORTING BURDEN FOR THE COLLECTION OF INFORMATION IS ESTIMATED TO AVERAGE 30 MINUTES PER RESPONSE,
INCLUDING THE TIME FOR REVIEWING INSTRUCTIONS, SEARCHING EXISTING DATA SOURCES, GATHERING AND MAINTAINING THE
DATA NEEDED, AND COMPLETING AND REVIEWING THE COLLECTION OF INFORMATION. SEND COMMENTS REGARDING THIS BURDEN ESTIMATE OR ANY OTHER ASPECT OF THE COLLECTION INFORMATION, INCLUDING SUGGESTIONS FOR REDUCING THE BURDEN TO: CHIEF, MARINE MAMMAL AND SEA TURTLE CONSERVATION DIVISION, OFFICE OF PROTECTED RESOURCES, NOAA FISHERIES, 1315 EAST-WEST HIGHWAY, SILVER SPRING, MARYLAND 20910. NOT WITHSTANDING ANY OTHER PROVISION OF THE LAW, NO
PERSON IS REQUIRED TO RESPOND, NOR SHALL ANY PERSON BE SUBJECTED TO A PENALTY FOR FAILURE TO COMPLY WITH, A
COLLECTION OF INFORMATION SUBJECT TO THE REQUIREMENTS OF THE PAPERWORK REDUCTION ACT, UNLESS THE COLLECTION
OF INFORMATION DISPLAYS A CURRENTLY VALID OFFICE OF MANAGEMENT AND BUDGET (OMB) CONTROL NUMBER.

NOAA Form 89-878 (rev. 2007) OMB Control No. 0648-0178; Expiration Date: 10/31/2010