VS 4-106 Field Investigation of Brucellosis Market Test Reactors

Brucellosis Program

VS 4-106 Apr 2009

Brucellosis Program - Business

OMB: 0579-0047

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OMB Approved

0579-0047

USDA – aPHIS

field investigation of brucellosis

market test reaCtor(s)

1. MCT LOG (vs Form 4-100)

2. date investigation started


Book No.

Page No.

3. date bled

4. place bled


Mkt. Slau.

name and address of market or slaughter est.

5. name of testing lab.

state

6. backtagged

7. no. backtagged

Date

location

date

REACTOR ANIMAL(S)

(a)

back tag no.

(b)

ear tag no.

(c)

sales tag no.

(d)

other identification

(e)

plate test

(f)

card test

(g)

OPTIONAL TESTS

8.







9.







10.







(h)

SPECIES

(i)

BREED

(J)

COLOR

(K)

SEX

(L)

AGE

(M)

VAC. STATUS

(N)

SCALE WT. (lb.)

(O)

LIVE WT. (lb.)

8.








9.








10.








TRACING TO ORIGIN

11. NAME AND ADDRESS OF CP CONSIGNOR


(a)

cOUNTY

(b)

NO. ANIMALS MOVED

WITH REACTOR



12. NAME AND ADDRESS OF OWNER (If different from consignor)



herd information

13. date of last herd infection

None

14. date of last mct reactor

None

15. date of last positive brt

None

16. percent of herd vaccinated for bruc.


%

17. clinical signs of bruc. in herd


Yes No Unknown

18. time reactor in herd

19. type of herd

Dairy

Beef

Both

20. cattle census on premises

a. cows

b. bulls

c. steers

d. calves under 12 mo.

e. heifers 1-2 years

(1) Vac.

(2) nv

(1) Vac.

(2) nv

21. herd scheduled for test

22. has herd been quarantined



Yes No

Date (If “Yes”)

Date

By

NO (If “No” explain fully in item 24.)

tracking exposed animals

23. animals from this consigment sold

(a)

no. animals

(b)

name and address of buyer

sold for

(e)

identification no.

(Back tag, Sale tag, etc.)

(c)

slau.

(d) return to farm


























24. remarks (Attach a separate sheet.)

25. investigator (Signature)




26. title

27. date

VS FORM 4-106

APR 2009

Form Copy Designations


Part 1

Part 2

Part 3

Part 4


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 Bykahardy
File Modified2009-04-14
File Created2009-04-02

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