Vs 5-19A Flock Inspection and Epidemiology Report Initial Flcok I

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 2 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.

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

OMB APPROVED
0579-0101

SCRAPIE SFCP FLOCK INSPECTION REPORT
Initial Flock Inspection for Export Monitored Status in the
Scrapie Free Flock Certification Program (SFCP)

Owner Name, Address, and Email Address

Flock Location(s) if Different

Premises ID
Telephone
Inspector
Inspection Date

County

Type of Operation (check all that apply and circle primary activity)
Breeder (seed stock)

Inspector ID

Inspector Initials

Latitude

Longitude

INVENTORY

Commercial (breeder)
Dairy

Males (<12 mos)

Other __________________________

Females (<12 mos)

Veterinary Practitioner Name

0

0

Wethers (<12 mos)
Wethers (≥ 12 mos)

Predominant Breed(s)

TOTAL
Yes

GOATS

Adult females (≥ 12 mos)

Club Lamb/Kid

Species

SHEEP

Adult males (≥ 12 mos)

INSPECTION CHECKLIST
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.
Discussed 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 the 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 is 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.
The flock owner understands that in addition to the records above the following records need to be kept for 7 years:
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 must be provided with the required records.
The implications of the following activities on flock status and status date were discussed:
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.
Flock owner was given a copy of and was informed that he/she must comply with all requirements listed in the SFCP Standards.
Attach Copy of Flock Inventory
Comments (if more space needed, use an attached sheet):

Flock Owner Signature

Date

AVIC Signature

Date

VS FORM 5-19A
JUNE 2013

Yes

No

Application Form Completed (VS Form 5-22)

Yes

No

Flock Owner Received a Copy of SFCP Standards

Yes

No

Flock Meets Program Standards

(Previous editions are obsolete)