VS 4-54D Monthly Report of Brucellosis Program Surveillance Activ

Brucellosis Program

VS 4-54D Mar 2009

Brucellosis Program - State

OMB: 0579-0047

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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 0579-0047. The time required to complete this information collection is estimated to average 4 hours 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 NO.

0579-0047

Expiration Date

00/00/0000

MONTHLY REPORT OF BRUCELLOSIS

PROGRAM SURVEILLANCE ACTIVITIES

STATE NAME




STATE/AREA CLASS

MONTH AND YEAR

SECTION A – BLOOD TESTS ON MARKET CATTLE ORIGINATING IN THIS STATE

STATE WHERE SAMPLES WERE TESTED (If more space is needed use additional forms)

A.

IDENTI

FICATION

INITIAL SAMPLES COLLECTED AT:

TOTAL TESTED

Ranch or Farm

Stockyards

Federally Inspected Slaughter Plants

State inspected

Slaughter Plants

Cattle

B.

Reactors

C.

Cattle

D.

Reactors

E.

Cattle

F.

Reactors

G.

Cattle

H.

Reactors

I.

Cattle

J.

Reactors

K.

1. MCI Cattle Tested in

this State

a. Backtagged











b. Other ID











c. No ID











2.

a. Backtagged











b. Other ID











c. No ID











3.

a. Backtagged











b. Other ID











c. No ID











4.

a. Backtagged











b. Other ID











c. No ID











5.

a. Backtagged











b. Other ID











c. No ID











6.Total Cattle Tested which Originated in this State

a. Backtagged











b. Other ID











c. No ID











d. TOTAL











SECTION B – BLOOD TESTS ON MARKET CATTLE ORIGINATING IN OTHER STATES TESTED IN THIS STATE

STATE OF ORIGIN OF TESTED CATTLE

(if more space is needed use additional forms)

A.

IDENTI

FICATION

SAMPLES COLLECTED AT:

TOTAL TESTED

Ranch or Farm

Stockyards

Federally Inspected Slaughter Plants

State inspected

Slaughter Plants

Cattle

B.

Reactors

C.

Cattle

D.

Reactors

E.

Cattle

F.

Reactors

G.

Cattle

H.

Reactors

I.

Cattle

J.

Reactors

K.

7. MCI Cattle Tested in

this State

a. Backtagged











b. Other ID











c. No ID











8.

a. Backtagged











b. Other ID











c. No ID











9.

a. Backtagged











b. Other ID











c. No ID











10.

a. Backtagged











b. Other ID











c. No ID











11.

a. Backtagged











b. Other ID











c. No ID











12.Total Cattle Tested which Originated in this State

a. Backtagged











b. Other ID











c. No ID











d. TOTAL











SECTION C – SUMMARY OF CATTLE TESTED AT FARMS OR STOCKYARDS ALSO TESTED AT SLAUGHTER

IDENTI

FICATION



A.


TOTAL TESTED

Ranch of Farm

Stockyards

Cattle

B.

Reactors

C.

Cattle

D.

Reactors

E.

Cattle

F.

Reactors

G.

a. Backtagged







b. Other ID







SECTION D – SUMMARY OF BLOOD SAMPLE COLLECTIONS AT SLAUGHTER BY VS PERSONNEL OR CONTRACTOR

Plant No.

Expense

No. Samples

Plant No.

Expense

No. Samples

Plant No.

Expense

No. Samples





























VS 4-54D

MAR 2009


SECTION E – TRACEBACK OF MARKET CATTLE REACTORS

TYPE OF IDENTIFICATION

MCI Reactors Pending Herd


A.

Traced

to

Known Reactor Herd

B.

Traced

and test

Recom

mended


C.

Traced

and test

not

Recom

mended

D.

Traced

to

Dealer



E.

Traced

to

Feedlot



F.

Traced to Sold Out Herd

Traced

to Another State


I.

Unable to

Trace




J.

MCI Reactors Successfully Traced


K.

Single Reactor


G.

Multiple Reactors


H.

13. Backtagged












14. Other ID












15. No Identification












16. Number of Herds












SECTION F – BRUCELLOSIS MILK AND CREAM RING TEST RESULTS

RING TEST RESULTS – HERDS LOCATED IN THIS STATE REGARDLESS OF WHERE TESTED

Round Number

A.

TOTAL

NEGATIVE

SUSPICIOUS


Percent

Suspicious Herds

(F/B x 100)

H.


17.

Herds

(D + F)

B.

Estimated Cattle

(E + G)

C.


Herds

D.

Estimated Cattle

E.


Herds

F.


Estimated Cattle

G.

18. Milk







19. Cream







20. Total







SECTION G – SUMMARY OF BRUCELLOSIS TESTS IN OTHER SPECIES )Report Swine on VS Form 4-59)

SPECIES NAME

TOTAL TESTED

TOTAL REACTORS

Suspects

E.

Herds/Lots

A.

Animals

B.

Herds/Lots

C.

Animals

D.

21. Goats






22. Sheep






23. Horse






24. Bison






25. Deer






26. Elk






27. Canine






28. Other (Specify)






29.






30.






SECTION H – MONTHLY REPORT OF BRUCELLOSIS REACTOR HERDS/LOTS IN OTHER SPECIES


Herd/Lot ID Number



A.


Species




B.


C. Herd/Lot Name

County where herd/lot is Located



F.

Total Animals Tested



G.

Total Animals Tested



H.

Total Animals Tested



I.

Total Animals Tested



J.

Total Animals Tested




K.


D. City E. ZIP Code




C.








D. E.










C.








D. E.










C.








D. E.










C.








D. E.










C.








D. E.










C.







D. E.










C.








D. E.










C.








D. E.







SIGNATURE

TITLE

DATE



VS 4-54D (Reverse)


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 Modified2012-12-10
File Created2009-03-31

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