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pdfAccording 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
EXP DATE XX/XXXX
SCRAPIE PEMMP INSPECTION REPORT
Owner Name, Address, and Email Address
Flock Location if Different
Premises ID
Telephone
Inspector
Inspection Date
PEMPP Start Date
Inspector ID
County
Latitude
Longitude
Type of PEMPP
(
) Basic (no high risk animals retained)
(
) Infected/Source-Retained QQ Ewes
(
) Trace Flock-Retained Exposed QQ Ewes
(
) Nor98-like Scrapie
(
) Other _______________________________________________
( ) Valine Assoc. Infected/Source-Retained AVQR Ewes
Type of Operation (check all that apply and circle primary activity)
__________ Breeder (seed stock)
__________ Commercial (breeder)
__________ Club Lamb
__________ Feeder
__________ Dairy
__________ Other __________________________________
Veterinary Practitioner Name
Species
INVENTORY
1.
NA
0
0
Males (<12 mos)
Females (<12 mos)
Wethers (<12 mos)
Wethers (≥ 12 mos)
TOTAL
NO
GOATS
Adult females (≥ 12 mos)
Predominant Breed(s)
YES
SHEEP
Adult males (≥ 12 mos)
INSPECTION CHECKLIST
If “No” for any item, explain in comments.
Sheep and/or goats inspected and found free of scrapie
2. Clinical signs suggestive of scrapie observed by the producer or inspector (check all that apply):
3.
(
)
No clinical signs of scrapie
(
)
Excitable, aggressive, or other abnormal behavior
(
)
Incoordination
(
)
Nibbling and licking movements
(
)
Weight loss
(
)
Convulsions
(
)
Intense itching/rubbing with wool loss
(
)
Skin abrasions, from rubbing
(
)
Involuntary muscle tremors
(
)
Other (describe): _____________________________________________
Animals exhibiting signs of scrapie or found dead at over 14 months were immediately reported to a State or APHIS representative.
4. Written or computer records kept documenting the following:
4a.
Application of Official ID to all animals ≥ 12 months of age in the flock and animals that have left the premises except as permitted for
animals in slaughter channels under 12 months of age.
Type(s) of Official ID used: ____________________________________________________.
4b.
Acquisitions – official ID, date of purchase, name and address of the person from whom the animal was acquired and all identifying
marks or tags on the animal.
4c.
Animals Removed – official ID, date of removal, and the name and address of the person to whom the animal was transferred.
4d.
Deaths – official ID, date of death, and cause of death if known. Record of submission for scrapie testing of obex and lymph node
from animals that died at over 14 months of age.
5.
Exposed QR or RR ewes that were not removed or redesignated as part of the flock plan are retained until they die, are slaughtered,
or are euthanized, and tissues are submitted from these sheep for official testing as directed by APHIS or the State.
6.
Number of restricted exposed QR or RR ewes (from #5) remaining in flock ____________________________.
7.
Number of sire rams by genotype: RR ____________QR ___________QQ __________Unknown _____________.
8.
Discussed notification and tissue submission procedure for testing animals that die at over 14 months of age.
9.
Animals designated for testing are retained until they have a valid (“PrPsc not detected”) live-animal test result, or until they die or
are euthanized and have tissues submitted for official testing.
10.
Exposed ewes with QQ genotype retained in flock (if YES complete 11-21; if NO skip to 22).
VS Form 5-19C
FEB 2011
Page 1
****ALL FLOCKS RETAINING EXPOSED QQ or Other Genetically Susceptible Exposed SHEEP****
11. Additional Recordkeeping Requirements Met
YES
NO NA
11a.
Sex.
11b.
Species and breed (or cross), and if unknown, face color (sheep) or type (goats, i.e. meat, dairy, or fiber).
11c.
Date of birth or estimated month and year of birth.
11d.
Sire’s and dam’s official and any secondary ID numbers, including registration number (if known).
11e.
Offspring’s official and any secondary ID numbers, including registration number (if known).
Documentation that all genetically susceptible exposed ewes that were not removed as part of the flock plan were bred
12.
only to RR rams while on the PEMMP.
Documentation that all genetically susceptible exposed ewes that were not removed as part of the flock plan, and in the
case of previously infected/source flocks any susceptible ewes that were added to flock while on the PEMMP and before
13.
all exposed ewes were removed, were retained until they died, were slaughtered, or were euthanized, and tissues
submitted from the sheep for official testing.
****TRACE FLOCKS RETAINING EXPOSED QQ or Other Genetically Susceptible Exposed SHEEP****
YES
NO
NA
Number of Exposed QQ sheep remaining in the flock ____________________
14.
Animals that were born after the high-risk animal lambed are sold only direct to slaughter unless they are negative on
live-animal test at over 14 months of age or have been genotyped and are RR or QR at codon 171. (The offspring of an
RR ram, when only RR rams are present on the premises, meet this requirement.)
15.
****PREVIOUSLY INFECTED/SOURCE FLOCKS RETAINING EXPOSED QQ OR OTHER GENETICALLY SUSCEPTIBLE EXPOSED SHEEP****
YES
NO
NA
16.
Number of Exposed QQ sheep remaining in the flock ____________________
17.
Sexually intact female sheep that are of unknown, QQ or other susceptible genotypes and female goats are only
removed from the premises by permit for slaughter, destruction, or research. (When only RR rams are present on the
premises, offspring are considered R? sheep if they have not been genotyped.)
18.
19.
20.
No female goats have been added to the flock by purchase or natural addition until all genetically susceptible exposed
ewes have been removed or this plan completed.
After each lambing, placenta and bedding are disposed of by burial, incineration or composing in an area to which
animals do not have access.
Confined lambing facilities are cleaned at the conclusion of the lambing season in accordance with the guidelines
published in the Scrapie Flock Certification Program standards.
21. Genetically susceptible ewes which are retained or are acquired
21a.
Are live-animal tested and found negative at over 14 months of age and prior to lambing. NOTE: Susceptible sheep
added to the flock after completion of the flock cleanup plan are to be tested at owner expense.
21b.
Are maintained separate and apart from the rest of the flock.
21c.
Are identified with at least two forms of official ID including the APHIS provided EID.
Only double tested RR rams are kept in the separate area where genetically susceptible ewes are maintained. (Male
animals born in the area where genetically susceptible ewes are maintained must be castrated or removed to another
premises before they reach sexual maturity.)
21d.
22. Comments (if more space needed, use an attached sheet):
Flock Owner Signature
Date
Inspector Signature
Date
VS 5-19C
FEB 2011
PAGE 2
| File Type | application/pdf |
| File Title | According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond |
| Author | Government User |
| File Modified | 2011-12-15 |
| File Created | 2011-06-08 |