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

Scrapie in Sheep and Goats; Interstate Movement Restrictions and Indemnity Program

VS 5-19B Mar 2010

Private Sector

OMB: 0579-0101

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According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond 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 to average 1 hour 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.

OMB APPROVED

0579-0101

EXP DATE XX/XXXX

UNITED STATES DEPARTMENT OF AGRICULTURE

ANIMAL AND PLANT HEALTH INSPECTION SERVICE

VETERINARY SERVICES

FLOCK INSPECTION AND EPIDEMIOLOGY REPORT

Flock Inspection for Complete Export Monitored Status

In the Scrapie Flock Certification Program

Flock ID

Owner Name and Address



Flock Location if Different

PIN

Telephone

Inspector

Inspector ID

County

Inspection Date

Latitude

Longitude

Type of Flock

__________ Purebred

__________ Commercial

__________ Feeder

__________ Other __________________


SHEEP

­­­­­









INVENTORY

Adult Males

Adult Females

Yearling Males

Yearling Females

Female Lambs/Kids

Male Lambs/Kids

Castrated Males

Total

GOATS









Veterinary Practitioner Name


Species

Predominant Breed

Yes

NO

INSPECTION CHECKLIST



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 both scrapie suspect animals and animals found dead, 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 addition (name, date, and address of previous owner, status in SFCP).



Purpose, reason, date, and buyer name and address for animals which are sold. Are all assumed to have been removed because they died? If not, should the other option(s) be noted?



Disposition of removed animals: died, date, and cause, any practitioner diagnosis, if done.



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



Records of sheep and goats sold as breeding animals and official ID applied and records of any other sheep and goats sold or disposed of.

HAVE ANY OF THE FOLLOWING ACTIVITIES OCCURRED OVER THE LAST YEAR?



Commingling of sheep with another producer’s sheep.



Purchase of does/ewes from another producer.



Purchase of bucks/rams from another producer.



Use of semen and embryos.



Copy of Flock Inventory Attached.

Comments:


















FLOCK OWNER SIGNATURE


INSPECTOR SIGNATURE



VS 5-19B

MAR 2010

File Typeapplication/msword
File TitleAccording to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond
AuthorGovernment User
Last Modified Bysmharris
File Modified2011-12-14
File Created2010-02-05

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