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

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.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
Flock ID

OMB APPROVED
0579-0101

SCRAPIE SFCP FLOCK INSPECTION REPORT
Annual Inspection Report for Scrapie Free Flock Certification Program
Export Category Flocks

Owner Name, Address, and Email Address

Flock Location(s) if Different

Premises ID
Telephone
Inspector
Inspection Date

County

Flock Inspection for (check one):

Export Monitored Flock

Type of Operation (check all that apply and circle primary activity)
Breeder (seed stock)
Commercial (breeder)
Club Lamb/Kid
Dairy
Other __________________________
Veterinary Practitioner Name

Inspector ID

Inspector Initials

Latitude

Longitude

Export Certified Flock
INVENTORY

SHEEP

GOATS

Adult males (≥ 12 mos)
Adult females (≥ 12 mos)
Males (<12 mos)
Females (<12 mos)
Wethers (<12 mos)

Species

Predominant Breed(s)

Wethers (≥ 12 mos)

TOTAL
0
0
INSPECTION CHECKLIST
Yes
No
If “No” for any item, explain in comments.
Sheep and goats inspected and found free of clinical signs of scrapie.
Sheep and goats inspected and inventoried and those over 12 months of age are officially identified.
Animal inventory reconciled with previous year’s inventory and any discrepancies were resolved.
Reviewed requirement and procedure for reporting of scrapie suspect animals and animals found dead, and submission
of samples.
Written or computer records match the inventory made during the inspection and records track the following information:
Official and any secondary identification or marks.
If “Yes,” type of official ID:
Sex.
Species and breed (or cross), or if breed unknown type (sheep: meat, dairy, or fiber and face color; goats: meat, dairy, or fiber).
Date of birth or estimated month and year of birth.
Flock of origin (name and address of previous owner) and date of entry for those not born in flock.
For registered animals, the registry and registration number.
Information on genotyping, if known.
Animal acquisitions: in addition to the items listed above, flock of origin ID number, status and status date in the SFCP at time of
acquisition.
Animal deaths: official ID, date died/found dead, diagnosis/cause and documentation of results of scrapie testing completed.
Animals sold/removed: official ID, reason removed, date removed and name/address of buyer.
Animals sold as SFCP-enrolled animals: the buyer was provided with the required records.
Flock owner reported or the inspector noted the following activities since last inspection (If “Yes” for any item, explain in comments.):
Commingling of sheep/goats with sheep/goats of another flock or resided on the premises of another flock.
Purchase of ewes/does and/or rams/bucks from another flock.
Use of semen and/or embryos, and/or sheep or goat milk or colostrum or products derived therefrom.
Failure to officially identify animals or to maintain accurate records, including a current inventory.
Failure to provide records to purchasers of animals sold as enrolled animals.
Failure to report animals exhibiting clinical signs of scrapie or to submit samples from these animals and animals found dead at
over 18 months of age.
Attach Copy of Flock Inventory
Comments (if more space needed, use an attached sheet):

Flock Owner Signature

AVIC Signature

VS FORM 5-19B
JUNE 2013

Date

Flock Meets Program Standards
Yes
No
Eligible for Advancement
Yes
No
(Previous editions are obsolete)

Date