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 5.5 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 APPROVED 0579-0101 EXP DATE XX/XXXX |
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UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE VETERINARY SERVICES |
SCRAPIE EPIDEMIOLOGY REPORT |
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Inspector |
Inspector ID
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County
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Inspection Date
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Quarantine Number |
Latitude |
Longitude |
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Type of Operation (check all that apply and circle primary activity)
__________ Breeder (seed stock) __________ Commercial (breeder) __________ Club Lamb __________ Feeder __________ Dairy __________ Other ________________________________________
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Veterinary Practitioner Name
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Species |
Predominant Breed(s) |
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1. Number of sheep or goats currently in the flock with clinical signs suggestive of scrapie: sheep:____________ goats:________________
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2. Clinical signs suggestive of scrapie observed by the producer or inspector (check all that apply):
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3. Approximate date when the first clinical signs suggestive of scrapie were seen: ________________ |
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4. Total number of sheep and/or goats that have shown clinical signs suggestive of scrapie in the past 5 years: ___________. |
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5. Number of adult deaths from all causes over the last year: ____________. |
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6. Number of rams with official genotype results: _______________; number with unofficial genotype results: _______________. (Attach copies of genotype records, if available.) |
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7. Number of ewes with official genotype results: _______________; number with unofficial genotype results: _______________. (Attach copies of genotype records, if available.) |
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8. Check the type of records kept: ( ) Record of official ID applied ( ) Sex ( ) Species and breed (or cross), or if breed is unknown, face color (sheep) or type (goats, i.e. meat, dairy, or fiber) ( ) Date of birth or estimated month and year of birth ( ) Contemporary lambing groups ( ) Animal sire and dam Information ( ) Sales information – ID, buyer, date sold ( ) Purchase information – ID, seller, date purchased ( ) Other (describe):_____________________________________________________________________________________
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VS Form 5-19D Epidemiology Page 1
FEB 2011
9. Description of lambing/kidding facilities:
10. How often is the lambing/kidding area cleaned and disinfected and describe process? If dates of cleaning and disinfection were recorded, attach copy of disinfection records.
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11. Are separate contemporary lambing/kidding groups used? YES (indicate in inventory which animals are in each group and attach supporting documentation)
NO |
12. Method of disposal of placentas:
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13. Method of disposal of dead sheep/goats:
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14. Use an attachment to document the following information on each laboratory confirmed case and/or clinically suspicious animal currently in the flock. Additionally, complete as much information as possible on any clinical suspects that have resided in the flock over the last 5 years.
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15. Use an attachment to document the following information on the offspring of all female scrapie confirmed cases and the animal’s disposition.
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16. Use an attachment to document the following information on all purchased sheep/goats acquired at least 2 yrs before the first positive animal was diagnosed and up to 5 years before the positive animal was born or acquired unless a source flock has been identified. If a source flock has been identified (i.e., the infected animal was purchased and under 72 months of age), you can limit this information to the animals acquired from the source flock.
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VS Form 5-19D Epidemiology Page 2
FEB 2011
17. Use an attachment to document the following information on all sheep/goats sold or otherwise disposed of since the positive animal(s) was born or acquired (Do not include lambs less than 12 months of age sold directly to slaughter).
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18. Use an attachment to document the following information on the current flock inventory.
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Investigator Signature
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Title
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Date
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VS Form 5-19D Epidemiology Page 3
FEB 2011
File Type | application/msword |
Author | smharris |
Last Modified By | smharris |
File Modified | 2011-12-13 |
File Created | 2011-06-21 |