VS Form 9-9 Hatchery Inspection Report

Clear Form
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 0579-0007. The time required
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data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

OMB APPROVED
0579-0007
EXP: XX/XXXX

1. NAME AND MAILING ADDRESS OF HATCHERY (include ZIP code)

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
THE NATIONAL POULTRY IMPROVEMENT PLAN

HATCHERY INSPECTION REPORT
2. CLASSIFICATION OF PRODUCTS

3. DAYS OF WEEK ON WHICH CHICKS ARE HATCHED

U.S. PULLORUM-TYPHOID CLEAN

U.S. AI CLEAN

U.S. M. GALLISEPTICUM CLEAN

U.S. S. ENTERITIDIS CLEAN

U.S. M. SYNOVIAE CLEAN

U.S. SALMONELLA MONITORED

U.S. M. MELEAGRIDIS CLEAN

MONDAY

THURSDAY

TUESDAY

FRIDAY

WEDNESDAY

SATURDAY

SUNDAY

U.S. SANITATION MONITORED

OTHER (specify)
4. INCUBATORS
A. NUMBER

B. MAKE

C. MODEL

D. EGG CAPACITY (setting and hatching trays)

5. COMPLIANCE
SAT

UNSAT

SAT

(affiliated flocks)

Egg and chick purchases
(other sources)

Selecting and testing report
Sales

ID OF

Eggs in incubator
Products sold
Products purchased
Egg cleanliness
Egg size
Egg shell texture
Egg shell color (tint - white eggs)

FOR AREA OF LOCATION

RECORDS

Egg purchases

UNSAT

SAT

Handling of market eggs

General hatchery cleanliness

Advertising

Incubator cleanliness

Egg receiving

Incubator tray disinfection

Incubation

Hatchery biosecurity

Hatching

Disposal of waste

Chick holding

Incubator fumigation

Waste disposal

Rodent and insect control program

Tray cleaning

Egg processing area

Storage

Hatching tray cleanliness

Work flow in hatchery

Hatchery fumigation/disinfected

Hatchery ventilation

Egg/chick/poult truck biosecurity

6. BREEDING STOCK FOR SUPPLY FLOCK REPLACEMENT
A. NAME AND SOURCE OF FLOCK OF ORIGIN

B. CODE
P - PRIMARY
M - MULTIPLIER

C. OFFICIAL CLASSIFICATION

7. REMARKS (include recommendations for correction of unsatisfactory compliance)

8. SIGNATURE OF HATCHERYMAN

VS FORM 9-9
JAN 2005

9. SIGNATURE OF STATE INSPECTOR

10. DATE

UNSAT