State, Local, Tribal Government

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UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE VETERINARY SERVICES 2150 CENTRE AVE, BLDG B FORT COLLINS, CO 80526	COMMERCIAL TABLE EGG FLOCK CASE CONTROL SURVEY

The information you provide will be used for statistical purposes only. Your responses will be kept confidential and any person who willfully discloses ANY identifiable information about you or your operation is subject to a jail term, a fine, or both. This survey is conducted in accordance with the Confidential Information Protection and Statistical Efficiency Act of 2018, Title III of Pub. L. No. 115-435, codified in 44 U.S.C. Ch. 35 and other applicable Federal laws. For more information on how we protect your information please visit: https://www.nass.usda.gov/confidentiality. Response is voluntary.

Study ID: frmid

Date (mm/dd/yy): date

Instructions

The U.S. Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) and state and industry partners are conducting a case-control study as part of the highly pathogenic avian influenza (HPAI) investigation efforts to identify factors that may contribute to the transmission of H5N1 influenza virus to poultry.

We are asking you to fill out this survey to provide information on daily farm activities, facility and premises condition, deliveries to the farm, and ill birds. This survey covers a 2-week (14-day) period on the farm starting on a specific date that we will provide. We recommend using a pocket calendar or other agenda manager and any feed and other delivery records that might be available to assist in recalling the requested information.

Term	Case definition	Control definition
Premises	Farm location with flocks confirmed to be HPAI H5N1 infected by NVSL, including all barns and buildings, even if not all barns and buildings contain infected birds.	Farm location with no HPAI H5N1 infected birds in any barn or building, in same state as case farm.
House/barn	Barn or building that houses HPAI H5N1-infected birds.	On control premises, a barn or building that does not house any HPAI H5N1 infected birds.

Dates of study focus:

Case farms answer questions for the time frame of 14 days prior to the onset of clinical signs or increased mortality. All questions that ask about the “reference period” refer to this time period.

Control farms answer questions for the time frame of 14 days prior to date of first detection on the matched case farm. All questions that ask about the “reference period” refer to this time period.

Section A - Case or Control

1. Is this a case or control farm? e201
   ₁ Case [Go to question 2.]

₃ Control [Go to question 3.]

2. If this is a case farm,

a. When were clinical signs or increased mortality first observed?

(This is what we will refer to as the reference date.). e202 mm/dd/yy

b. Enter the date 14 days prior to the date of first detection.

(Clarifying time frame of study focus.) e203 mm/dd/yy

All questions regarding the “reference period” refer to the 14 days
prior to the reference date (the time between “a” and “b”).
We will refer to this as the “reference period.”

c. How many birds were on this farm on the reference date? e204 # birds

d. On the reference date, was this farm in an existing control zone? e205 ₁ Yes ₃ No

e. When was the flock diagnosed as positive by laboratory confirmation? e206 mm/dd/yy

f. During the 2022 outbreak, how many of the barns on this farm were confirmed
or were suspected to be infected with HPAI? e207 # barns

[Go to Section B.]

3. If this is a control farm,

a. Enter reference date.

(Enter date of matched case farm prior to interview.) e208 mm/dd/yy

b. Enter the date 14 days prior to the reference date. e209 mm/dd/yy

All questions regarding the “reference period” refer to the 14 days
prior to the reference date (the time between “a” and “b”).
We will refer to this as the “reference period.”

c. How many birds were on this farm on this reference date? e210 # birds

d. Was this farm located in a control zone during the reference period? e211 ₁ Yes ₃ No

e. Was this farm located in a control zone during some other time frame? ₁ Yes ₃ No

f. If Yes to either d or e, what was the total time this farm was in a control zone? days

OR weeks

Section B - Premises Description

1. What stages of production of egg-type poultry are on this farm?

a. Pullets e302 ₁ Yes ₃ No

b. Layers e303 ₁ Yes ₃ No

c. Breeders e304 ₁ Yes ₃ No

d. Other (specify: ) e305oth e305 ₁ Yes ₃ No

2. What other type(s) of poultry are present on this farm?

a. Turkey e306 ₁ Yes ₃ No

b. Broiler e307 ₁ Yes ₃ No

c. Other (specify: ) e308oth e308 ₁ Yes ₃ No

3. Is this farm certified organic? e309 ₁ Yes ₃ No

4. Is this facility enrolled in NPIP? e310 ₁ Yes ₃ No

5. Is this farm multiple age or single age? [Check one only.] e311

₁ Multiple age

₂ Single age

6. How many barns are on this farm? e312 # barns

7. How many barns are:

a. Conventional cage housing? e313 #

b. Enriched caged housing? e314 #

c. Cage-free (certified organic)? e315 #

d. Cage-free (not certified organic)? e316 #

Total (must equal question 6 response) e317 #

8. Do any birds on the farm have access to the outdoors? e318 ₁ Yes ₃ No

9. Are any poultry on this farm pastured? e319 ₁ Yes ₃ No

10. Were other non-poultry livestock and animals (such as beef or dairy cattle, horses, sheep, goats, or pigs) or pets (such as dogs or cats) present on the farm premises during the reference period?

₁ Yes ₃ No

11. Did any non-poultry livestock on the farm, or located within 350 yards of the farm, receive supplemental feed (for example, hay or grain) during the 14-day reference period?

(350 yards is about the length of three football fields.) ₁ Yes ₃ No  N/A ₄ Don’t Know

12. Were other poultry or domesticated waterfowl (noncommercial) present on the farm premises during the 14-day reference period? e347 ₁ Yes ₃ No

13. What is the water source for poultry?

a. Municipal e349 ₁ Yes ₃ No

b. Well e350 ₁ Yes ₃ No

c. Surface water (e.g., pond) e351 ₁ Yes ₃ No

d. Other (specify: ) e352oth e352 ₁ Yes ₃ No

14. Are water treatments such as chlorination used in the drinking water for the poultry on this farm?

₁ Yes ₃ No

14a. If Yes, are these treatments given ₁ continuously or ₃ intermittently?

15. Are windbreaks present on this farm?

Windbreak type	Present?	If Yes, distance to closest poultry barn (in yards)
a. Evergreen or juniper	1 Yes 3 No	_______ yards	e358/e361
b. Deciduous tree	1 Yes 3 No	_______ yards	e359/e362
c. Structural (for example, hill, natural break)	1 Yes 3 No	_______ yards	e360/e363

16. Excluding driveways on the farm, what is the distance (in yards or miles)

from this farm to the nearest public gravel or dirt road? e364y yards

e364m OR miles

17. Are the following water body type(s) visible or within 350 yards (about three football fields) of this farm?

a. Pond e320 ₁ Yes ₃ No

b. Lake e321 ₁ Yes ₃ No

c. Stream e322 ₁ Yes ₃ No

d. River e323 ₁ Yes ₃ No

e. Wetland or swamp or marsh e324 ₁ Yes ₃ No

f. Wastewater lagoon e325 ₁ Yes ₃ No

g. Drainage ditch ₁ Yes ₃ No

h. Other (specify: ) e326oth e326 ₁ Yes ₃ No

18. For those water bodies within 350 yards, including drainage ditches and lagoons, approximately how many wild waterfowl or shorebirds might have been seen on the water during the 14-day reference period?

₁ None

₂ Tens

₃ Hundreds

₄ Thousands

19. What is the distance (in yards) of the closest body of water (for example, pond, lake, stream, river, wetland) to this farm? yards

Specify this water body type:

20. Approximately how many wild waterfowl (for example, ducks, geese) or shorebirds might have been seen on this body of water at one time? (Try to answer the question for the 14-day reference period.)

₁ None

₂ Tens

₃ Hundreds

₄ Thousands

21. What is the distance (in yards) to the closest field where crops or hay are harvested? e331

yards (up to 350 yards)

21a. If no fields are within 350 yards, please check here. ₁

22. What crop was being grown in this field during the 14-day reference period? [Check one only.] e332

₁ Corn

₂ Soybeans

₃ Alfalfa or grass intended for livestock feed

₄ Other (specify: ) e332oth

23. Was this field tilled last fall? e333 ₁ Yes ₃ No ₄ Don’t know

24. Was this field actively worked (for example, tilled, disked) during the 14-day reference period? e334

₁ Yes ₃ No ₄ Don’t know

25. For this closest field, approximately how many wild waterfowl (for example, ducks, geese) or shorebirds were seen during the 14-day reference period?

₁ None – Skip to next section

₂ Tens

₃ Hundreds

₄ Thousands

26. What type(s) of waterfowl or shorebirds were observed in the field in the 14-day reference period?

a. Ducks e240 ₁ Yes ₃ No ₄ Don’t Know

b. Geese e241 ₁ Yes ₃ No ₄ Don’t Know

c. Shorebirds (for example, wading birds, gulls) e242 ₁ Yes ₃ No ₄ Don’t Know

d. Other (specify: ) e243/e243oth ₁ Yes ₃ No ₄ Don’t Know

Section C - Wild Birds

1. Were the following types of wild birds seen on the farm but outside of the barns (within 100 yards) during the 14-day reference period?

Bird type	Often	Sometimes	Never
a. Large birds (for example, pigeons, crows)	1	2	3
b. Small birds (for example, finches, sparrows, starlings)	1	2	3
c. Waterfowl or shorebirds	1	2	3
d. Other (specify: _________________________) e515oth	1	2	3

2. How frequently were the following types of wild birds seen in the barns during the 14-day reference period?

Bird type	Often	Sometimes	Never
a. Large birds (for example, pigeons, crows)	1	2	3	e510
b. Small birds (for example, finches, sparrows, starlings)	1	2	3	e511
c. Other (specify: _________________________) e512oth	1	2	3	e512

3. Did you observe any of the following types of dead wild birds in the barns or outside the barns during the 14-day reference period?

Dead bird type	Inside the barns	Outside the barns
a. Large birds (for example, pigeons, crows)	1 Yes 3 No	1 Yes 3 No	e513/e516
b. Small birds (for example, finches, sparrows, starlings)	1 Yes 3 No	1 Yes 3 No	e514/e517
c. Other (specify: __________________) e515oth	1 Yes 3 No	1 Yes 3 No	e515/e518

Section D - Farm Biosecurity

1. Is there a house with people living in it on the property? e401 ₁ Yes ₃ No

[If question 1 = No, SKIP to question 3.]

2. Is there a common drive entrance to farm and residence? e402 ₁ Yes ₃ No

3. How many entrances are there to the farm that could provide access to the poultry area?

e403 #

4. What best describes the road surface on this farm that vehicles coming onto the operation drive on? [Check one only.] e404

₁ Hard top/asphalt

₂ Gravel

₃ Dirt

₄ Other (specify: ) e404oth

5. In general, do the following types of vehicles:

Codes for question 5

1 = come to the perimeter of the farm only

2 = enter the farm but not near the barns

3 = come near the barns

4 = N/A

Enter the codes that apply

a. Garbage/dumpster pick up? e405 code

b. Propane delivery? e406 code

c. Feed delivery? e407 code

d. Feed ingredient delivery? code

e. Renderer? e408 code

f. Company personnel (for example, processing plant and barn workers, service person, veterinarian)? e409 code

g. Egg trucks moving eggs off the farm

(for example, to processing, for breaking, to the consumer market)? e410 code

h. Egg truck moving eggs to the farm (such as, sideloading)? e411 code

i. Other business visitors (for example, meter reader, repairman)? e412 code

6. In general, how many vehicles (including employee vehicles) come to the following locations on a weekly basis?

Perimeter of the farm only vehicles per week

Enter the farm but not near the barns vehicles per week

Come near the barns vehicles per week

7. Is there a gate to this farm entrance? e413 ₁ Yes ₃ No

[If question 7 = No, SKIP to question 9.]

8. Is the gate secured/locked? e414 ₁ Always ₂ After hours only ₃ Never

9. Is the farm area perimeter surrounded by a security fence? e415 ₁ Yes ₃ No

10. How frequently is vegetation mowed/bush hogged on the premises?

(Answer for when vegetation is present, for example, spring and summer.) e416 times/month

11. Was there a wash station/spray area being used for vehicles during the 14-day reference period?

e417 ₁ Yes ₃ No

[If question 11 = No, SKIP to question 13.]

12. For wash station/spray area:

a. Is it located on the farm? e418 ₁ Yes ₃ No

b. Are the tires washed? e419 ₁ Yes ₃ No

c. Is the vehicle exterior washed? e420 ₁ Yes ₃ No

d. Is the vehicle interior cleaned (for example, floor mats) e421 ₁ Yes ₃ No

e. Which vehicles are washed?

i. Worker vehicles e422 ₁ Yes ₃ No

ii. Feed trucks e423 ₁ Yes ₃ No

iii. Egg trucks e424 ₁ Yes ₃ No

iv. Other (specify: ) e425oth e425 ₁ Yes ₃ No

f. What disinfectant is used? e426

g. Was the wash station: [Check one only.] e427

₁ Recently put into use as a response to heightened biosecurity concerns.

₂ A permanent station (such as, in use prior to the HPAI incident).

h. What is the distance from the wash station to the nearest barn in yards? yards

13. Did workers and visitors park in a restricted area away from the barns during the 14-day reference period?

1. Workers e428 ₁ Always ₂ Sometimes ₃ Never

2. Visitors e429 ₁ Always ₂ Sometimes ₃ Never

14. What pest and wildlife control measures were used on this farm during the 14-day reference period?

1. Rat and mouse bait stations e430 ₁ Yes ₃ No

If Yes, how frequently are they checked e431 times/month

2. Beetle control e432 ₁ Yes ₃ No

If Yes, type:

15. Overall, how severe a problem were rodents during the 14-day reference period?

[Check one only.] e445

₁ High (for example, significant damage to building, significant impact on layer health or feed efficiency)

₂ Moderate (for example, moderate damage to building, moderate impact on layer health or feed efficiency)

₃ Low (for example, minor impact on building or feed efficiency)

₄ No problem

16. Do you monitor rodent index as part of your rodent control program? e446 ₁ Yes ₃ No

Note: Rodent index (RI) is the equivalent of number of mice caught in 7 days with 12 traps using the formula: RI = (number of mice caught) x (7/days trapped) x (12/number of traps).

[If question 16 = No, SKIP to question 18.]

17. Which of the following ranges best describes your rodent index during the 14-day reference period? [Check one only.] e447

₁ Low (0 to 10 mice)

₂ Medium (11 to 25 mice)

₃ High (26 or more mice)

18. During the 14-day reference period, were wild mammals, such as raccoons, opossums, coyotes, or foxes (or evidence of their presence), seen in or around poultry barns? e448 ₁ Yes ₃ No

19. During the 14-day reference period, prior to feeding, how frequently did wild birds, wild animals, and rodents have access to poultry feed or feed ingredients (for example, feed spillage, open bag, cover left open)?

For this question, “Always” is 100% of the time, “Most of the time” is 51-99% of the time, “Sometimes” is 1-50% of the time, and “Never” is 0% of the time.

Type	Always	Most of the time	Sometimes	Never
a. Wild birds	1	2	3	4	e449
b. Wild animals, such as raccoons, opossums, coyotes, or foxes	1	2	3	4	e450
c. Rodents	1	2	3	4	e451

20. Does this premises have a wildlife management plan? ₁ Yes ₃ No ₄ Don’t know

21. Describe the protocol or plan for when feed spills on your farm? e452

22. What form of feed is fed to the poultry?

a. Mash e453 ₁ Yes ₃ No

b. Pellets e454 ₁ Yes ₃ No

c. Other (specify: ) e455oth e455 ₁ Yes ₃ No

23. Is the feed treated with:

a. Formaldehyde (such as Termin-8)? e456 ₁ Yes ₃ No

b. Antimicrobial (for example, ionophores)? e457 ₁ Yes ₃ No

c. Other? (specify: ) e458oth e458 ₁ Yes ₃ No

24. Is the feed heat treated? e459 ₁ Yes ₃ No

25. Considering the following biosecurity topics, how challenging would you say these are for producers to achieve? Please check one box per row.

	Not at all challenging	Slightly challenging	Somewhat challenging	Quite challenging	Extremely challenging
a. Keeping feed safe from rodents	1	2	3	4	5
b. Keeping feed safe from wildlife	1	2	3	4	5

Section E - Farm Help/Workers

Questions in this section refer to persons such as the producer, employees, farm help, crews, and similar.

1. What is the total number of employees working on this farm who have access to or directly work with poultry facilities (including family, both paid and unpaid)? e601 #

2. Did this farm use occasional or emergency workers such as family members or part-time help to fill in for any employees during the 14-day reference period? ₁ Yes ₃ No

3. During the 14-day reference period, how frequently were the following measures required for workers entering the poultry barns?

For this question, “Always” is 100% of the time, “Most of the time” is 51-99% of the time, “Sometimes” is 1-50% of the time, and “Never” is 0% of the time.

Measure	Always/ nearly always	Most of the time	Sometimes	Never
An established clean/dirty line	1	2	3	4	e602
Shower	1	2	3	4	e603
Wash hands or use hand sanitizer before entering the barn	1	2	3	4	e604
Different personnel for different barns	1	2	3	4	e605
Wear disposable coveralls	1	2	3	4	e606
Change of clothing (washable)	1	2	3	4	e607
Change of shoes or use of shoe covers	1	2	3	4	e608
Foot bath (liquid)	1	2	3	4	e609
Foot bath (dry)	1	2	3	4	e610
Scrub footwear (bucket and brush)	1	2	3	4	e611

4. Is there a policy in place to prevent workers on this farm from working on other farms?

e612 ₁ Yes ₃ No

5. Are workers or members of their household employed by other poultry operations, rendering plants, or processing plants? e613 ₁ Yes ₃ No

6. Do any employees own their own poultry, including small backyard flocks? e614

₁ Yes ₃ No ₄ Don’t know

7. Are employees required to stay off farm after exposure to other poultry? e615 ₁ Yes ₃ No

If Yes, for how long (hours)? e616 hours

8. Considering the following personnel-related topics, how challenging would you say these are for producers to achieve?

	Not at all challenging	Slightly challenging	Somewhat challenging	Quite challenging	Extremely challenging
a. Hiring new personnel	1	2	3	4	5
b. Retaining trained personnel	1	2	3	4	5
c. Communicating the importance of biosecurity to personnel	1	2	3	4	5
d. Enforcing daily biosecurity measures	1	2	3	4	5
e. Other personnel-related challenges (Please describe: _______________________)	1	2	3	4	5

Section F - Farm Visitors

1. Is a visitor log used to record visitor traffic onto the farm? e701 ₁ Yes ₃ No

2. Did any of the following types of people visit the farm during the 14-day reference period?

If Yes, how many times did they visit and did they enter the poultry barn?

Visitor type	Did they visit the farm?	If Yes,
		How many times did they visit?	Did this visitor enter the poultry barn?
a. Federal/State veterinary or animal health worker	1 Yes 3 No	_____ # visits	1 Yes 3 No	e702/e720/e738
b. Extension agent or university veterinarian	1 Yes 3 No	_____ # visits	1 Yes 3 No	e703/e721/e739
Visitor type	Did they visit the farm?	If Yes,
		How many times did they visit?	Did this visitor enter the poultry barn?
c. Private or company veterinarian	1 Yes 3 No	_____ # visits	1 Yes 3 No	e704/e722/e740
d. Company service person	1 Yes 3 No	_____ # visits	1 Yes 3 No	e705/e723/e741
e. Nutritionist or feed company consultant	1 Yes 3 No	_____ # visits	1 Yes 3 No	e706/e724/e742
f. Feed ingredient delivery person	1 Yes 3 No	_____ # visits	1 Yes 3 No
g. Pullet delivery	1 Yes 3 No	_____ # visits	1 Yes 3 No	e707/e725/e743
h. Vaccination crew	1 Yes 3 No	_____ # visits	1 Yes 3 No	e708/e726/e744
i. Catch crew	1 Yes 3 No	_____ # visits	1 Yes 3 No	e709/e727/e745
j. Feed delivery personnel	1 Yes 3 No	_____ # visits	1 Yes 3 No	e710/e728/e746
k. Egg truck personnel	1 Yes 3 No	_____ # visits	1 Yes 3 No	e711/e729/e747
l. Bedding/new litter services (delivery, pick up)	1 Yes 3 No	_____ # visits	1 Yes 3 No	e712/e730/e748
m. Customer (private individual)	1 Yes 3 No	_____ # visits	1 Yes 3 No	e713/e731/e749
n. Wholesaler, buyer, or dealer	1 Yes 3 No	_____ # visits	1 Yes 3 No	e714/e732/e750
o. Renderer	1 Yes 3 No	_____ # visits	1 Yes 3 No	e715/e733/e751
p. Dead bird pickup other than by renderer	1 Yes 3 No	_____ # visits	1 Yes 3 No
q. Occasional worker (for example, family member, part-time help over holiday)	1 Yes 3 No	_____ # visits	1 Yes 3 No	e716/e734/e752
r. Construction workers, repair or maintenance personnel	1 Yes 3 No	_____ # visits	1 Yes 3 No	e717/e735/e753
s. Other business visitors (including other producers, meter readers, package delivery (UPS), propane, etc.)	1 Yes 3 No	_____ # visits	1 Yes 3 No	e718/e736/e754
t. Other nonbusiness visitors (including neighbors, family members, friends, and school field trips)	1 Yes 3 No	_____ # visits	1 Yes 3 No	e719/e737/e755

3. For those visitors who entered the poultry barn during the 14-day reference period, did you require the following?

	Yes, verified at farm	Yes, visitor responsibility	No
a. Change of outer clothing/farm specific clothing	1	2	3	e756
b. Foot covers or change of footwear	1	2	3	e757
c. Mask	1	2	3	e758
d. Hand sanitizing, handwashing, or gloves	1	2	3	e759
e. Not visit multiple farms in the same day	1	2	3	e760
f. Other (specify:____________________)e761oth	1	2	3	e761

4. What are some of the biggest visitor-related challenges to biosecurity that producers face?
Please describe:

_____________________________________________________________________________

Section G - Farm Vehicles and Equipment

1. Were the following vehicles shared with another farm during the 14-day reference period?
If Yes, were they cleaned and disinfected prior to returning to this farm?

Vehicle type	Shared with another farm in the 14-day reference period?	If Yes, was it cleaned and disinfected prior to returning to this farm?
Company trucks/trailers (for example, pickup truck, trailer with supplies, supervisor truck, or similar)	1 Yes 3 No	1 Yes 3 No 2 Sometimes	e801
Feed trucks	1 Yes 3 No	1 Yes 3 No 2 Sometimes	e802
Feed ingredient truck	1 Yes 3 No	1 Yes 3 No 2 Sometimes
Pullet delivery vehicles (for example, placing pullets)	1 Yes 3 No	1 Yes 3 No 2 Sometimes	e803
Bird removal vehicles	1 Yes 3 No	1 Yes 3 No 2 Sometimes	e804
Egg delivery vehicles	1 Yes 3 No	1 Yes 3 No 2 Sometimes	e805
Vehicle type	Shared with another farm in the 14-day reference period?	If Yes, was it cleaned and disinfected prior to returning to this farm?
Egg removal vehicles	1 Yes 3 No	1 Yes 3 No 2 Sometimes	e806
Manure/litter hauling	1 Yes 3 No	1 Yes 3 No 2 Sometimes	e807
ATV/4-wheeler	1 Yes 3 No	1 Yes 3 No 2 Sometimes	e808
Other (specify: ______________________________) e809oth	1 Yes 3 No	1 Yes 3 No 2 Sometimes	e809

2. Were the following pieces of equipment shared with another farm during the 14-day reference period? If Yes, were they cleaned and disinfected prior to returning to this farm?

Equipment type	Shared with another farm in the 14-day reference period?	If Yes, was it cleaned and disinfected prior to returning to this farm?
Gates/panels	1 Yes 3 No	1 Yes 3 No 2 Sometimes	e810
Lawn mowers	1 Yes 3 No	1 Yes 3 No 2 Sometimes		e811
Live haul loaders	1 Yes 3 No	1 Yes 3 No 2 Sometimes		e812
Egg racks or pallets	1 Yes 3 No	1 Yes 3 No 2 Sometimes		e813
Egg flats	1 Yes 3 No	1 Yes 3 No 2 Sometimes		e814
Pressure sprayers/washers/foamers	1 Yes 3 No	1 Yes 3 No 2 Sometimes		e815
Skid-steer loaders	1 Yes 3 No	1 Yes 3 No 2 Sometimes		e816
Litter/manure handling	1 Yes 3 No	1 Yes 3 No 2 Sometimes		e817
Mortality bin	1 Yes 3 No	1 Yes 3 No 2 Sometimes
j. Other (specify: __________________________) e819oth	1 Yes 3 No	1 Yes 3 No 2 Sometimes		e818

3. Considering the following equipment-related topics, how challenging would you say these are for producers to achieve?

	Not at all challenging	Slightly challenging	Somewhat challenging	Quite challenging	Extremely challenging
Keeping shared vehicles cleaned and disinfected	1	2	3	4	5
Keeping shared small equipment (such as egg racks or flats) cleaned and disinfected	1	2	3	4	5
Other equipment or vehicle-related challenges (Please describe: __________________________)	1	2	3	4	5

Section H - Egg Handling

1. During the 14-day reference period, were any eggs from this farm marketed as:

a. Shell eggs? e901 ₁ Yes ₃ No

[If question 1a = No, SKIP to question 1b.]

i. Washed and sanitized eggs? e902 ₁ Yes ₃ No

ii. Nest runs? e903 ₁ Yes ₃ No

b. Liquid eggs (sent to further processing)? e904 ₁ Yes ₃ No

2. Which best describes the primary location for shell egg processing (washing, grading, and packing into cartons)? [Check one only.] e905 ₁ On-farm

₂ Off-farm

[If question 2 = Off-farm (2), SKIP to question 4.]

3. Are shell eggs from other farms processed on this farm (for example, side-loading)?

e906 ₁ Yes ₃ No

[SKIP to Section I.]

4. When shell eggs are processed off-farm, what is the:

a. Average number of days between egg pickups from the farm? e907 days

b. Distance (in miles) to the processing plant where the majority of the eggs are processed.

e908 miles

3. Are poultry present on the property where the processing facility is located?

e909 ₁ Yes ₃ No

Section I - Litter and Manure Handling

1. Is litter (bedding) used on this farm? e1001 ₁ Yes ₃ No

[If question 1 = No, SKIP to question 9.]

2. Was litter brought onto the farm during the 14-day reference period? ₁ Yes ₃ No

If Yes, what was the last day litter was brought onto the farm during the reference period?

e1002 mm/dd/yy

3. Who brings litter onto the farm: [Check one only.] e1003

₁ Company personnel?

₂ Litter provider?

₃ Other? (specify: ) e1003oth

4. Is the litter heat treated prior to delivery? e1004 ₁ Yes ₃ No ₄ Don’t know

5. Is litter stored on the farm prior to use:

1. Outside? e1005 ₁ Yes ₃ No

If Yes, is it covered? e1006 ₁ Yes ₃ No

b. In a shed? e1007 ₁ Yes ₃ No

If Yes, is the shed closed? e1008 ₁ Yes ₃ No

[If both questions 5a and 5b = No, SKIP to question 8.]

6. What is the minimum distance (in yards) from the on-site litter storage area to the nearest barn?

e1009 yards

7. Prior to use, is litter accessible to:

1. Wild birds? e1010 ₁ Yes ₃ No

2. Wild animals (for example, raccoons, opossum, coyotes, foxes)? e1011 ₁ Yes ₃ No

3. Domestic animals (for example, dogs, cats)? e1012 ₁ Yes ₃ No

8. What was the date that litter was last removed from any barn on this farm prior to the end of the reference period? e1013 mm/dd/yy

9. Was manure or used litter from other farms spread on this farm or adjacent farms prior to or during the reference period? e1014 ₁ Yes ₃ No

If Yes, what was the last date this occurred? e1015 mm/dd/yy

10. Which of the following manure-handling methods are used for barns on this operation?

a. High rise (pit at ground level with house above) e1016 ₁ Yes ₃ No

b. Deep pit (below ground) e1017 ₁ Yes ₃ No

c. Shallow pit (ground level) e1018 ₁ Yes ₃ No

d. Raised slats over floor (no manure belt) e1019 ₁ Yes ₃ No

e. Flush system to a lagoon or slurry pit e1020 ₁ Yes ₃ No

If Yes, is lagoon water used to flush barns? e1021 ₁ Yes ₃ No

f. Manure belt e1022 ₁ Yes ₃ No

g. Scraper system (not flush or pit) e1023 ₁ Yes ₃ No

h. Drop board e1024 ₁ Yes ₃ No

11. Excluding belt system, how often is manure removed from the barn? e1025m #/month

e1025y OR #/year

12. Is manure stored on-farm (not including high-rise pits)? e1026 ₁ Yes ₃ No

[If question 12 = No, SKIP to question 15.]

13. Is manure stored:

a. In an enclosed building? e1027 ₁ Yes ₃ No

b. In an open structure (for example, three-sided building)? e1028 ₁ Yes ₃ No

c. In a lagoon? e1029 ₁ Yes ₃ No

d. Outside other than lagoon? e1030 ₁ Yes ₃ No

14. What is the minimum distance (in yards) from the on-site manure storage area to the nearest barn?

e1031 yards

15. How was manure disposed of during the 14-day reference period?

a. Composted on-farm e1032 ₁ Yes ₃ No

If Yes,

i. What is the distance (in yards) to the nearest poultry barn? e1033 yards

ii. Is litter composted in a composting building? e1034 ₁ Yes ₃ No

b. Applied to land on this farm e1035 ₁ Yes ₃ No

If Yes, what was the date litter was applied to land? e1036 mm/dd/yy

c. Taken off-site e1037 ₁ Yes ₃ No

Section J - Dead Bird Disposal

1. What is the approximate normal daily mortality on this farm? e1101 # birds/day

Note: Ratio this number to number of birds in section A, question 2c or 3c (page 2). Verify if the mortality is more than 0.01 (1 percent).

2. What are the method(s) of dead bird (daily mortality) disposal on this farm?

a. Composting e1102 ₁ Yes ₃ No

If Yes, is this onsite ₁ or offsite ₃?

b. Burial e1103 ₁ Yes ₃ No

If Yes, is this onsite ₁ or offsite ₃?

c. Incineration e1104 ₁ Yes ₃ No

d. Rendering e1105 ₁ Yes ₃ No

e. Landfill e1106 ₁ Yes ₃ No

f. Other (specify: ) e1107oth e1107 ₁ Yes ₃ No

3. If question 2a (composting) or question 2b (burial) is Yes, how frequently are carcasses covered with:

a. Soil? e1108 ₁ Daily ₂ Every 2 or more days ₃ Never

b. Manure? e1109 ₁ Daily ₂ Every 2 or more days ₃ Never

4. If question 2d (rendering) is Yes,

a. Is the carcass bin kept covered? e1110 ₁ Yes ₃ No

b. Are carcasses: [Check one only.] e1111

₁ Taken by the producer/worker to the renderer?

₂ Picked up by the renderer from the farm?

c. How many times were carcasses moved to the renderer during the 14-day reference period?

e1112 # times

5. Were any wild birds or wild mammals observed around the dead bird collection area (such as burial, compost pile, rendering bin, or similar) during the 14-day reference period?

a. Wild birds e1114 ₁ Yes ₃ No

b. Wild mammals e1115 ₁ Yes ₃ No

Barn-Level Questions

Instructions:

1. Control farm: Select one barn to complete this section. Answer questions for the 14 days prior to the reference date specified on page 2 (reference period).

2. Case farm: Select the first barn on this premises that was confirmed to be HPAI positive. Answer questions for the 14 days prior to the onset of clinical signs or increased mortality (reference period).

1. What is the barn ID?		e1201
2. What type(s) of poultry are present in this barn?
Pullet	1 Yes 3 No	e1202
Layer	1 Yes 3 No	e1203
Breeder	1 Yes 3 No	e1204
Other	1 Yes 3 No If Yes, specify: ______________	e1205/ e1205oth
Are there multiple ages of birds in the barn?	1 Yes 3 No
3a. If yes, how many times have birds been placed in the barn?	_________times
4. How many birds were placed in this barn?	_____ # birds	e1206
5. What was the date of placement in this barn? If there is more than one placement date, please select the date that applies to most birds in the barn.	_________ mm/dd/yy	e1207
6. How old were birds when placed in this barn?	_____weeks	e1208
7. Has this flock been molted?	1 Yes 3 No	e1209
8. Did birds in this barn have outside access?	1 Yes 3 No	e1210/ e1210oth
9. What was the bird density in the barn?	_______ sq in/bird	e1211
10. Was there another health concern in this flock during the 14-day reference period?	1 Yes 3 No If Yes, specify condition: ______________ ______________	e1212
11. Was this flock being treated for a condition or health concern during the 14-day reference period?	1 Yes 3 No If Yes, specify treatment: ______________ ______________ If Yes, specify condition: ______________ ______________	e1213
12. Was this flock vaccinated during the 14-day reference period?	1 Yes 3 No	e1214/ e1214oth
13. How are birds housed in this barn? [Enter code 1, 2, or 3.] 1. Conventional cage 2. Enriched cage 3. Cage-free	_____ code [If 3 (Cage-free), SKIP to question 16.]	e1215
14. Are cages curtain backed?	1 Yes 3 No	e1216
15. Do birds have access to droppings from other birds (e.g., manure belt running across top tier of cage)?	1 Yes 3 No	e1217
16. How old is this barn structure?	_____ years	e1218
17. How long has it been since the last remodel of the outside physical barn structure?	_____ years_____	e1219
17a.Please describe other updates to the barn: When were these performed? Ventilation system update Manure system update Other (please describe): _______________________	1 Yes 3 No Date:______________ 1 Yes 3 No Date:______________ 1 Yes 3 No Date:______________	e1220
18. How well has the barn structure been maintained? [Enter code 1, 2, or 3.] 1. Well For example, concrete foundation, no visible daylight, the barn is tight, intact inlet vent screens, doors well sealed 2. Moderate For example, barn tin could have rust or small holes, intact inlet vent screens, doors not completely sealed 3. Poor For example, holes in walls are apparent, tin is rusted, may have leaks in roof, there might be some holes large enough for wild birds to enter, multiple areas with daylight visible, inlet vent screens not intact, doors not sealed	_____ code
19. What type of ventilation was used for this barn during the 14-day reference period? [Enter code 1, 2, 3, or 4.] 1. Curtain ventilated 2. Side wall inlet 3. Ceiling or eaves inlet 4. Tunnel ventilation (may have side wall or ceiling inlets)	_____ code	e1221
20. Where are fans located?	1 Sidewall 2 End of barn 3 Both	e1222
21. Is intake air filtered?	1 Yes 3 No If Yes, specify type of filter: ______________	e1223
22. Which best describes the ground surface immediately surrounding (within 1 yard) this barn (excluding vehicle approach and loading area). [Enter code 1, 2, 3, or 4.] 1. Gravel or hard surface 2. Dirt 3. Short grass 4. Tall grass or brush	_____ code	e1225/ e1225oth
23. Does this barn have a hard-surface entry pad (for example, concrete, asphalt)?	1 Yes 3 No	e1226a/ e1226b
If Yes, a. Is the entry pad cleaned and how frequently?	1 Yes, 3 No If Yes, specify frequency: _______________	e1227
b. Is disinfectant used?	1 Yes 3 No If Yes, specify disinfectant: _______________	e1228/ e1229
24. How frequently were the following used in this barn during the 14-day reference period?
Locks on the doors	1 Always 2 Sometimes 3 Never	e1230
A service room that personnel must enter through separating “outside area” from “inside area”	1 Always 2 Sometimes 3 Never
Changing area for employees	1 Always 2 Sometimes 3 Never	e1231
A shower for employees	1 Always 2 Sometimes 3 Never	e1232
Cool cell pads	1 Always 2 Sometimes 3 Never	e1233
Misters	1 Always 2 Sometimes 3 Never	e1234
25. What type of footbath was used in this barn during the 14-day reference period? [Enter code 1, 2, 3, 4, or 5.] 1. Dry (i.e., powdered or particulate) 2. Liquid 3. Both dry and liquid 4. Other 5. None	_____ code If 4 (Other), specify: _______________ [If 5 (None), SKIP to question 30.]	e1235
26. What is the frequency that footbath solutions are changed?	_____ times/ 1 day, 2 week, or 3 month	e1236
27.What disinfectant is used in the footbaths?	Specify: ____________	e1237/ e1237oth
28. Does this barn have drop boards?	1 Yes 3 No	e1238/ e1238f
29. What type(s) of litter is used in this barn? [Enter Code 1, 2, 3, or 4.] 1. None (skip to question 39) 2. Wood shavings 3. Hulls (for example, oat, rice, sunflower, other) 4. Straw 5. Other	_____ code If 5 (Other), specify: _______________	e1240
30. Is the litter bagged (such as bailed) or bulk (such as load from shavings mill)?	1 Bag 2 Bulk	e1241
31. Was litter “tilled” after it was placed in the barn?	1 Yes 3 No	e1243
If Yes, when was it tilled?	__________ mm/dd/yy	e1244
32. How many times was litter added to the barn during the 14-day reference period?	_________ times	e1245
33. What was the date of the last full clean out of manure and litter?	__________ mm/dd/yy	e1246
34. Were birds present during the last full clean out?	1 Yes 3 No	e1247
35. Who performed the last full clean out? [Enter Code 1 or 2.] Producer Contractor	_____ code	e1248
36. Were the following wild birds seen in this barn during the 14-day reference period?
Large birds (for example, pigeons, crows)	1 Yes 3 No	e1250
Small birds (for example, finches, sparrows, starlings)	1 Yes 3 No
37. Were wild waterfowl observed on the nearest body of water during the 14-day reference period?	1 Yes 3 No	e1252
38. How far is this barn (in yards) from:
Dead bird disposal/holding area including carcass bin for rendering?	____ yards	e1254
Nearest road?	____ yards
39. Did any of the following types of people enter this barn during the 14-day reference period?
Federal/State veterinary or animal health worker	1 Yes 3 No	e1256
b. Extension agent or university veterinarian.	1 Yes 3 No
c. Private or company veterinarian	1 Yes 3 No	e1257
d. Company service person	1 Yes 3 No	e1258
e. Nutritionist or feed company consultant	1 Yes 3 No	e1259
f. Pullet delivery	1 Yes 3 No	e1260
g. Vaccination crew	1 Yes 3 No	e1261
h. Catch crew (bird removal)	1 Yes 3 No	e1262
i. Feed delivery personnel	1 Yes 3 No	e1263
j. Egg truck personnel	1 Yes 3 No	e1264
k. Litter services (delivery, pick up)	1 Yes 3 No	e1265
l. Customer (private individual)	1 Yes 3 No	e1266
m. Wholesaler, buyer, or dealer	1 Yes 3 No	e1267
n. Renderer	1 Yes 3 No	e1268
o. Occasional worker (for example, family member, part time help over holiday)	1 Yes 3 No	e1269
p. Construction workers, repair, or maintenance person	1 Yes 3 No	e1270
q. Other business visitors (including other producers, meter readers, package delivery (UPS), or similar)	1 Yes 3 No	e1271
r. Other nonbusiness visitors (including neighbors, friends, and school field trips)	1 Yes 3 No	e1272
If this is a control barn, skip to the next section. If this is a case barn, continue.		e1273
40. Where specifically in this barn did increased mortality or clinical signs first appear (for example, near entry, near vents, back of barn)? [A diagram may help.]	Describe: ___________________ ___________________	e1274
41. Was there a pattern of spread in the barn?	1 Yes 3 No If Yes, describe: ___________________ ___________________	e1275/ e1276
42. What was the first indication of infection within the barn?
a. Surveillance testing	1 Yes 3 No	e1276/ e1276oth
b. Premovement testing	1 Yes 3 No
c. Increased mortality	1 Yes 3 No	e1277
d. Clinical signs	1 Yes 3 No If Yes, specify: ___________________ ___________________

Comment Section

Please use this section for anything else that you would like to add. For example, how do you think HPAI was/is spreading within your geographic area?

____________________________________________________________________________________

Checklist

Instructions

This section refers to data that can be acquired through other sources.

1. Please verify grayed areas from the questionnaire.

2. If possible, attach a diagram, farm map, or photographs showing orientation of barn(s), including barn numbers, water location, feed storage, rendering bin, dead bird disposal, litter storage, ventilation, and windbreaks.

3. If this is a case farm, for the first infected barn, attach a diagram including proximity of initial infection to vents, doors, personnel entrances, manure storage, and other potential contributing factors.

4. How many commercial poultry farms (of any production type) are located:

a. Within 1 mile of this farm? e1401 #

b. Within 3 miles of this farm? e1402 #

5. How far (in yards or in miles) is the nearest backyard flock to this farm? e1403y yards

e1403m OR miles

6. How far (in yards or in miles) was the nearest HPAI-positive premises to this farm?

e1404y yards

e1404m OR miles

7. Collect mortality sheets from both case and control barns for the 14-day reference period.

8. Collect ventilation control records from both case and control barns for the 14-day reference period.

Interview Information

Study ID: frmid

EMRS (premises) ID: premid

Date (mm/dd/yy): date

Interviewer instruction: Bring satellite image of farm to interview at a neutral off-site location determined ahead of the scheduled interview.

Premises Information

Farm name: frmname

Farm address: frmadd

County: frmcty Township: frmtsp

Lat: frmlat Long: frmlong

1. Supervisor contact name: e101 Phone: e102

Cell phone: e103 Email: e104

2. Farm manager contact name: e105 Phone: e106

Cell phone: e107 Email: e108

3. Flock veterinarian: e109 Phone: e110

Cell phone: e111 Email: e112

Interviewer information

Interviewer name/organization: intrname

Interviewee name/organization: intename

38