Marine Mammal Human Interaction Form

OMB Control No. 0648-0178; Expiration Date: 3/31/2020

marinE mammaL Human intEraction REPORT
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Exam Information (fill in or circle most appropriate)
Field #: ____________________________________

Species: _________________________________

Examiner: __________________________________

Recorder: ________________________________

Date of exam:_______________________________

Condition code (at exam): 1

Preservation: alive fresh

frozen

frozen/thawed

Body condition: emaciated

Documentation:

print

slide

Image disposition:__________________________

Integument :

digital

normal

abnormal

video

decomposed

2

3

CBD

not emaciated

CBD

% Skin missing: <10% 10-25% 25-50% >50%

Explanation of terms:
YES = I have examined the area and/or found signs of this pathology, natural marking, or human interaction
NO = I have examined the area and/or did not find signs of this pathology, natural marking, or human interaction
CBD = I have examined the area and could not determine whether there were signs of human interaction (i.e. the
part was missing, degraded, or signs were ambiguous)
NE = I did not examine the area
NA = this animal doesn’t normally have that part (i.e. seals have no dorsal, dolphins have no rear flippers)

WHOLE BODY EXAM

YES

NO

CBD

NE

NA

Image taken

8 External pathology (pox, tattoo lesion, abscess, fungal patches)
9 Natural markings (scars, tooth rakes, unusual pigmentation)
10 Appendage(s) removed / Mutilation (with instrument)
11 Pelt removed / Mutilation (with instrument)
12 Body sliced / Mutilation

(with instrument)

13 Gear / Debris present on animal (including tags)
14 Gear / Debris retained (name & contact info in Comments)
15 HI lesions

(fishery, gunshot, propeller, healed HI scar, brand)

16 Predation / scavenger damage (circle all anatomical areas where damage hinders evaluation; numbers coincide
with anatomical areas below ):
17 18 19 20 21 22 23 24 25 26 27 28 29 NONE

FILL IN TABLE FOR ALL POSSIBLE FINDINGS OF HI

17 Rostrum/snout
18 Mandible
19 Head and/or neck
20 L Front appendage
21 R Front appendage
22 L Body
23 R Body
24 Dorsum/dorsal fin
25 Ventrum

26 Peduncle
27 L Rear appendage
28 R Rear appendage
29 Flukes/tail
* If Gear-Line is the lesion origin, mark the MO/MU/CBD column: "MO" for monofilament, "MU" for multifilament, and "CBD" if the type of line cannot be
determined. NOAA Form 89-864; OMB Control No.0648-0178; Expiration Date 03/31/2020

(2012)

IFAW & VAQS

Image taken?

Other / CBD

Gunshot

Propeller

Other / CBD

Packing Band

Hook

MO/MU/CBD*

Net

Other / CBD

Abrasion

NE/NA

Impression/
Laceration
Penetrating
wound
Healed HI
scar

CBD

NO

DETAILED EXAM OF
ANATOMICAL AREAS
YES

Origin of Lesion
Gear- Line Gear/Debris
Other

Type of Lesion

Twine / line

Do not use for natural markings/pathology.

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Internal exam conducted
Bruising/blunt trauma
Skeleton examined
Broken bones present
Mouth/GI tract examined

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Lungs/bronchi examined
Lung/bronchi contents
Bullet/projectile found
Other lesions noted

Detailed Info

Image
taken

CBD

Date ____________

Partial

INTERNAL EXAM

YES
NO

Field #:______________________

(circle all that apply)
Details in Comments section -use line number
Details in Comments section -use line number
Details in Comments section -use line number
Associated tissue reaction: YES
NO
CBD
intact prey
partially digested
hard parts only
debris/gear
empty
other
Details in Comments section -use line number

(circle contents)

froth
fluid
found using: CT

air
(color:
X-ray dissection (collected? Y

N )

)

Details in Comments section -use line number

39 Comments (note line number from left margin before each comment):

40 Findings of Human Interaction:
(transfer to Level A Datasheet)
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Type

□YES □NO □CBD

(Exam Type: external__ internal___ both ___)

of HI: (provide details in comments)

□ Entanglement (gear__ debris__ CBD__)
□ Vessel trauma (sharp__ blunt__ both__ )
□ Hooking (recreational__ commercial__ CBD__)
□ Mutilation
Gunshot
□ Ingestion (gear__ debris__ CBD__)
□ Harassment
□CBD/Other_________

42 Stranding

Event History/Circumstances:

43 INITIAL

HumAN INTErACTION EvALuATION: If you marked YES above (line 40) evaluate
the external exam, necropsy, carcass condition and circumstances surrounding the stranding
event to answer the question below. Remember to be conservative in your subjective evaluation.
What is the likelihood that the finding of human interaction (line 40), contributed to
the stranding event?

0: Uncertain (CBD)
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Justification:

1: Improbable

2: Suspect

3: Probable

Final human interaction evaluation requires additional data from level B and C analyses
as well as review by experts (e.g. a veterinary pathologist)
PAPERWORK REDUCTION ACT INFORMATION
PUBLIC REPORTING BURDEN FOR THE COLLECTION OF INFORMATION IS ESTIMATED TO AVERAGE 45 MINUTES 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. SEND COMMENTS REGARDING THIS BURDEN ESTIMATE OR ANY OTHER ASPECT OF THE COLLECTION
INFORMATION, INCLUDING SUGGESTIONS FOR REDUCING THE BURDEN TO: CHIEF, MARINE MAMMAL AND SEA TURTLE CONSERVATION DIVISION,
OFFICE OF PROTECTED RESOURCES, NOAA FISHERIES, 1315 EAST-WEST HIGHWAY, SILVER SPRING, MARYLAND 20910. NOT WITHSTANDING ANY OTHER
PROVISION OF THE LAW, NO PERSON IS REQUIRED TO RESPOND, NOR SHALL ANY PERSON BE SUBJECTED TO A PENALTY FOR FAILURE TO COMPLY WITH,
A COLLECTION OF INFORMATION SUBJECT TO THE REQUIREMENTS OF THE PAPERWORK REDUCTION ACT, UNLESS THE COLLECTION OF INFORMATION
DISPLAYS A CURRENTLY VALID OFFICE OF MANAGEMENT AND BUDGET (OMB) CONTROL NUMBER.

OMB Control No.0648-0178; Expiration Date 03/31/2020

IFAW & VAQS (2012)