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DAIRY CATTLE EMERGING HEALTH
EVENT: EPIDEMIOLOGICAL
QUESTIONNAIRE
OMB Approved
0579-XXXX
Exp. XX/XXXX
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
2150 CENTRE AVE, BLDG B
FORT COLLINS, CO 80526
Your participation is vital and will help APHIS understand the occurrence and extent of HPAI detections in
cattle. APHIS will safeguard study data as Confidential Business Information (CBI), as defined in the U.S.
Code of Federal Regulations (CFR) 19 CFR 201.6, and we will utilize exemption 4 for any Freedom of
Information Act (FOIA) (5 U.S. Code 552) requests for survey information associated with this study.
Response is voluntary and you may discontinue participation at any time.
Instructions
We are asking you to fill out this survey to provide information on daily farm activities, facility and
premises practices, deliveries to the premises, and sick cattle. The purpose of this survey is to better
understand the emerging health syndrome in dairy cattle first announced by USDA, March 25, 2024, and
to explore potential risk factors for infections in cattle. Any reports from this study will combine the data
from all participants. The results of this survey will be summarized to develop hypotheses and to identify
specific topics for future follow-up studies.
To support rapid data extraction and analysis, please use and save the fillable form electronically when
possible. The form can be downloaded and used on any device with Adobe Acrobat.
In the questionnaire, we frequently ask questions about a 30-day reference period. Questions regarding
the “30-day reference period” refer to the 30 days prior to the date that clinical signs were first
observed on the premises. You might find it helpful to have a calendar and your records handy.
a. Today’s date (mm/dd/yyyy): __________________
date1
b. Date first clinical signs observed (mm/dd/yyyy):___________________
date2
c. Date 30-days before first clinical signs observed (mm/dd/yyyy): ___________________
date3
All questions that ask about the “30-day reference period” refer to the dates between b. and c.
above.
April 12, 2024
Interviewer Notes - General Comments
1
April 12, 2024
Interviewer Notes - General Comments
2
Section A – Premises Information
National Premises Identification Number:
Name of premises:
premid
premname
Address of premises:
Street:
premstreet
City:
premcity
Zip Code:
premzip
County of premises:
-State: _______
_premstate
premcnty
Corporate affiliation/cooperative membership:
premcorp
Premises owner contact name:
ownname
Primary phone:
ownph
Email:
Premises manager name:
Primary phone:
mgrname
mgrph Email:
Premises veterinarian name:
Primary phone:
Interviewee contact name:
veteml
weename
weeph Email:
Interviewer contact name:
Primary phone:
mgreml
vetname
vetph Email:
Primary phone:
owneml
weeeml
wername
werph
Email:
werem
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April 12, 2024
Interviewer Notes - General Comments & Information Page
3
Section B – Case Information
1. For all cattle that have ever exhibited clinical signs of this syndrome, what clinical sign(s) were
observed? [Check all that apply.] d0001
Lactation related clinical signs:
Respiratory related clinical signs:
a Decreased milk production
i Increased respiratory rate
b Abnormal milk (e.g., consistency, color)
j Labored breathing
c Dry off early
k Nasal discharge
l Blood from nose
m Pneumonia
Digestive related clinical signs:
Other clinical signs:
d Decreased feed consumption
n Neurological signs
e Decreased rumen motility
o Blisters or ulcers
f Diarrhea/Loose manure
p Abortions
g Tacky, dry manure
q Lameness
h Constipation
r Fever (103 °F or greater)
s Dehydration
t Other (specify:
d0001oth)
2. For lactating cows with this syndrome that have produced abnormal milk, were any of the following
characteristics observed? [Check all that apply.] d0002
a Yellow discoloration
e Thickened
b Grey discoloration
f Flakes
c Clear
g Clots
d Apparent blood in milk
h Other (specify:
d0002oth)
3. On average, for cattle on this premises that have shown clinical signs of this syndrome:
a. How many days did they show clinical signs (excluding milk drop)?........... d0003
# days
b
# days
How many days did they experience milk drop? ......................................... d0004
4. When was the first time a veterinarian collected samples from cattle on this premises to diagnose the
cause of clinical signs due to this syndrome? .........................................
April 12, 2024
d0005
Interviewer Notes - General Comments & Questions B.1.- 4.
mm/dd/yy
4
5. Please complete the following table for the class and number of cattle on this operation today.
“Recovered” is defined as returning to the milking string even if there is not a full return to the
previous level of milk production; or, if non-lactating, are no longer receiving supportive care or
appear healthy. (Enter number of animals in whole numbers)
Cattle class
How many
animals of
this class
are on the
premises?
(If 0, go to
next class;
if >0,
continue
this class)
a. Preweaned
dairy or beef
calves
d0006
b. Weaned but
not bred
dairy heifers
c.
d0007
Bred dairy
heifers
d0008
d. 1st lactation
dairy cows
d0009
e. 2nd lactation
dairy cows
d0010
f.
3rd or greater
lactation
dairy cows
d0011
g. Dry dairy
cows
d0012
h. Beef cows,
bulls, steers,
and heifers
i.
How many
animals of
this class
have been
culled due
to this
syndrome?
How many
animals of
this class
have died
due to this
syndrome?
d0025
d0035
d0045
d0055
d0026
d0036
d0046
d0056
d0027
d0037
d0047
d0057
d0028
d0038
d0048
d0058
d0029
d0039
d0049
d0059
d0030
d0040
d0050
d0060
d0031
d0041
d0051
d0061
d0032
d0042
d0052
d0062
d0033
d0043
d0053
d0063
1 Yes
3 No d0016
1 Yes
3 No d0017
1 Yes
3 No d0018
1 Yes
3 No d0019
1 Yes
3 No d0020
1 Yes
3 No d0021
1 Yes
3 No d0022
1 Yes
3 No d0024
0
0
d0015
April 12, 2024
How many
animals of
this class
have
recovered
from this
syndrome?
d0013
Dairy bulls
Total (a. – i.)
How many
animals of
this class
have
exhibited
clinical
signs to
date?
1 Yes
3 No d0023
d0014
j.
Have any
animals of
this class
exhibited
clinical
signs to
date?
(If No, go to
next class;
if Yes,
continue this
class)
0
d0034
0
d0044
Interviewer Notes - General Comments & Question B.5.
0
d0054
d0064
5
6. During the reference period, were any dairy heifers from this premises being raised off-site with retained
ownership? ................................................................................................................. d0065
1 Yes 3 No
a. If Yes, which of the following best describes the off-site rearing facility? [Check only one.] d0066
Dairy heifers are sent to:
1 A single rearing facility and do not have any contact with cattle from other operations.
2 Multiple rearing facilities and do not have any contact with cattle from other operations.
3 A single rearing facility and have contact with cattle from other operations.
4 Multiple rearing facilities and have contact with cattle from other operations.
5 Other (specify:
d0066oth)
7. How many pens are on this premises? ............................................................. d0067
# pens
8. Have clinical signs been observed in multiple pens? ............................................. d0068
1 Yes 3 No
[If Yes, continue. If No, go to Section C.]
a. How many pens have animals that have exhibited clinical signs to date? . d0069
# pens
b. For each affected pen, what was the first day clinical signs were observed in the pen, the pen
number, the cattle class of the pen, and the average days in milk for cattle in the pen?
(If more space is needed, please use the continuation table at the end of the questionnaire. If
possible, please attach labeled site map. Enter average days in whole numbers)
Date clinical signs
were first observed in
the pen (mm/dd/yy)
Pen number
Cattle class
Pen average
days in milk
d0070a
d0070b
________________________________________
d0070c
d0070d
d0071a
d0071b
________________________________________
d0071c
d0071d
d0072a
d0072b
________________________________________
d0072c
d0072d
d0073a
d0073b
________________________________________
d0073c
d0073d
d0074a
d0074b
________________________________________
d0074c
d0074d
d0075a
d0075b
________________________________________
d0075c
d0075d
[Go To Continuation Table]
Click to go to Continuation Table
April 12, 2024
Interviewer Notes - General Comments & Questions B.6.- 8.b.
6
c.
Have animals showing clinical signs been observed in: [Check all that apply.] d0076
a Adjacent pens?
b Non-adjacent pens?
c Other (specify:
d0076oth)
d. For pens with lactating cows, has the order that pens have first shown clinical signs followed the
same order that those pens visit the milking parlor?............................ d0077
1 Yes 3 No 4 Don’t Know
e. If Yes, please describe:
d0078oth
Section C – Herd Description
1. During the 30-day reference period, which one of the following practices best describes this dairy
operation? [Check only one.] d0100
1 Conventional (majority of forage consumed is not harvested by cows)
2 Grazing (majority of forage consumed is harvested by cows during the growing season)
3 Combination of conventional and grazing
4 Other (specify:
d0100oth)
2. Of the dairy cows on this operation today, approximately what percent are:
a. Holstein?. ................................................................................................................. d0101
%
b. Jersey? .................................................................................................................... d0102
%
c.
%
Other, including mixed dairy breeds? (specify:
d0103oth) d0103
Total (should equal 100%) 0
%
3. Is this premises producing raw milk or raw/unpasteurized milk cheese products for human
consumption or for a cow share program? ............................................................. d0104
1 Yes 3 No
4. Is this premises certified organic? .......................................................................... d0105
1 Yes 3 No
5. During the 30-day reference period, what was the primary housing type used for each of the
following types of cattle while on this operation?
[Insert the appropriate housing type code from the table below.]
Housing type codes
1
Individual outside hutch/pen
5
Freestall with or without access to open/dry lot
2
Individual inside hutch/pen – heated or
nonheated calf barn
6
Open/dry lot/multiple animals outside area with
or without barn or shed (excludes pasture)
3
Tie stall or stanchion
7
Multiple animals inside area/barn
4
Pasture
8
Other (specify in Other column according to
cattle type)
April 12, 2024
Interviewer Notes - General Comments & Questions B.8.c.- C.5.
7
Other (specify)
a. Preweaned dairy heifers. .............................................. d0107/d0107oth
______________
b. Weaned, but not bred, dairy heifers. .............................d0108/d0108oth
_ _____________
c.
Bred dairy heifers .......................................................... d0109/d0109oth
______________
d. Lactating cows. .............................................................d0110/d0110oth
_ _____________
e. Dry cows. ......................................................................d0111/d0111oth
_ _____________
6. During the 30-day reference period, were the following animal types present on this operation?
If Yes, have any of these animal types been sick or died? Were any of the following animal types
present on an adjacent operation(s) where fence-line contact with this operation’s cattle was
possible?
On this operation?
(If Yes, answer Sick
column; if No, go to Have any animals of
Adjacent Operation this type been sick
column)
or died?
Animal type
1 Yes 3 No
4 Don’t know d0132
a. Dairy cattle
b. Beef cattle
1 Yes 3 No
1 Yes 3 No
d0112
d0122
c.
1 Yes 3 No
1 Yes 3 No
d0113
d0123
d. Horses, donkeys,
mules, or similar
1 Yes 3 No
1 Yes 3 No
d0114
d0124
e. Pigs (domestic)
1 Yes 3 No
1 Yes 3 No
d0115
d0125
f.
1 Yes 3 No
1 Yes 3 No
d0116
d0126
g. Sheep
1 Yes 3 No
1 Yes 3 No
d0117
d0127
h. Goats
1 Yes 3 No
1 Yes 3 No
d0118
d0128
i.
Dogs (domestic or feral)
1 Yes 3 No
1 Yes 3 No
d0119
d0129
j.
Cats (domestic or feral)
1 Yes 3 No
1 Yes 3 No
d0120
d0130
k.
Other
(specify:
1 Yes 3 No
1 Yes 3 No
d0121
d0131
Chickens or other
poultry
Pigs (feral)
)
d0121oth
April 12, 2024
On an adjacent
operation where fenceline contact with this
operation’s cattle was
possible?
Interviewer Notes - General Comments & Questions C.5.- 6.
1 Yes 3 No
4 Don’t know d0133
1 Yes 3 No
4 Don’t know d0134
1 Yes 3 No
4 Don’t know d0135
1 Yes 3 No
4 Don’t know d0136
1 Yes 3 No
4 Don’t know d0137
1 Yes 3 No
4 Don’t know d0138
1 Yes 3 No
4 Don’t know d0139
1 Yes 3 No
4 Don’t know d0140
1 Yes 3 No
4 Don’t know d0141
1 Yes 3 No
4 Don’t know d0142
8
7. Are there any commercial poultry operations located within 5 miles of this operation’s cattle herd?
1 Yes 3 No 4 Don’t Know
.................................................................................................... d0143
8. During the 30-day reference period, where were this operation’s dead cattle disposed?
[Check only one.] d0144
1 On-site
2 Off-site
3 Both
4 Not applicable – no deaths
Section D – Milking Procedures
1. What type of milking facilities are used on this operation? [Check all that apply.] d0201
a Parlor
b Tie stall or stanchion barn
c Robotic/voluntary milking systems
d Other (specify:
d0201oth)
2. During the 30-day reference period, how many times per day were the majority of cows milked?
[Check only one.] d0202
1 Once a day
2 Twice a day
3 Three times a day
4 More than three times a day
3. Are all cows milked the same number of times per day? ...................................... d0203
1 Yes 3 No
a. If No, does the frequency of milking seem to be associated with clinical signs? (i.e., has there
been a difference in the number of cows with clinical signs based on the number of times they were
milked per day?) ........................................................................ d0204
1 Yes 3 No 4 Don’t know
(1). If Yes to Question 3.a., please explain:
d0205oth
4. During the 30-day reference period, were the teats sprayed with water or another solution, excluding
pre-teat dip, prior to milking? .................................................................................. d0206
1 Yes 3 No
5. During the 30-day reference period, was forestripping performed prior to milking?
. ....................................................................................................................... d0207
6.
During the 30-day reference period, were teats pre-dipped prior to milking? ...... d0208
1 Yes 3 No
1
Yes
3
No
[If Yes, continue. If No, go to Question 7.]
April 12, 2024
Interviewer Notes - General Comments & Questions C.7.-D.6.a.
9
a. Please specify product used:
April 12, 2024
Interviewer Notes - General Comments & Questions C.7.-D.6.a.
d0209oth
10
b. What method was used to apply pre-dip? [Check only one.] d0210
1 Teat dipping cup
2 Teat sprayer
3 Automatic brush with scrubber and dryer
4 Other (specify:
d0210oth)
7. During the 30-day reference period, how were the teats dried prior to milking? [Check all that apply.]
d0211
a Paper towel used on one cow only
b Paper towel used on more than one cow
c Cloth towel used on one cow only
d Cloth towel used on more than one cow
e Not applicable – teats were not dried
8. During the 30-day reference period, were teats post-dipped after milking?........ d0212
1 Yes 3 No
a. If Yes, please specify product used:
d0213oth
9. During the 30-day reference period, did this operation use a backflush system in milking units?
................................................................................................................................ d0214
1 Yes 3 No
a. If Yes, was the backflush system:
(1). Used for every milking? ............................................................................. d0215
1 Yes 3 No
1 Automatic 2 Manual
(2). Automatic or manual?.............................................................. d0216
(3). Does the backflush system include a disinfectant?................................... d0217
1 Yes 3 No
10. During the 30-day reference period, did parlor workers wear disposable gloves while milking cows?
........................................................................................... d0218
1 Always
2Sometimes
3Never
a. If Always or Sometimes, on average how many cows were contacted while wearing a single pair of
gloves? [Check only one.] d0219
1 Only 1 2 2–10 3 11–50 4 51–100 5 101+
[If this operation has a parlor, continue. If not, go to Question 13.]
11. During the 30-day reference period, was the parlor cleaned after each milking shift?
........................................................................................... d0220
1Always
2Sometimes 3Never
a. If Always or Sometimes, which of the following best describes the cleaning procedures? [Check
only one.] d0221
1 Wash parlor with water or steam only
2 Chemically disinfect only
3 Wash with water and chemically disinfect
4 Other (specify:
April 12, 2024
d0221oth)
Interviewer Notes - General Comments & Questions D.6.b.-11.
11
12. Does this operation use a CIP (clean in place) system? ..................................... d0222
1 Yes 3 No
a. If Yes, how many times a day is cleaning conducted? [Check only one.] d0223
1 1
2 2
3 3
4 4 or more
13. Have any of the milking or parlor practices changed since the syndrome was first observed on this
premises?
.......................................................................................................... d0224
a. If Yes, please explain:
1 Yes 3 No
d0225oth
14. During the 30-day reference period, did milk trucks pick up partial semi-truck loads from this dairy?
...................................................................................................... d0226 1 Yes
3 No 4 Don’t Know
15. During the 30-day reference period, approximately how much waste milk was produced daily on this
premises?
.............................................................................................
d0227
(gallons/day)
16. During the 30-day reference period, which of the following practices were used to dispose of waste
milk on this premises? For each practice used, was the waste milk pasteurized/heat treated, chemical
treated, or not treated prior to the disposal practice?
Practice to dispose of waste milk:
(If checked, answer Treatment column)
[Check all that apply.] d0228
Treatment prior to the disposal practice?
[Check all that apply.]
a Fed to calves on this dairy
a Pasteurized/ heat treated
b Chemical treatment c No treatment
d0229
b Fed to calves at another premises
a Pasteurized/ heat treated
b Chemical treatment c No treatment
d0230
c Fed to swine (on or off-site)
a Pasteurized/ heat treated
b Chemical treatment c No treatment
d0231
d Fed to cats/dogs on the dairy
a Pasteurized/ heat treated
b Chemical treatment c No treatment
d0232
e Disposed in lagoon
a Pasteurized/ heat treated
b Chemical treatment c No treatment
d0233
a Pasteurized/heat treated
b Chemical treatment c No treatment
d0234
f Other (specify:
)
d0228oth
17. Have the waste milk disposal and/or waste milk treatment practices changed since the syndrome was
first observed on this premises? ......................................................................... d0235
April 12, 2024
Interviewer Notes - General Comments & Questions D.12.-17.
1 Yes 3 No
12
a. If Yes, how have practices changed:
d0236oth
Section E – Animal Movements
1. Were animals of the following cattle classes added to this premises during the 30-day reference
period?
Added to the premises
during the 30-day
reference period?
Cattle class
a. Preweaned dairy or beef calves
1 Yes 3 No
b. Weaned but not bred dairy heifers
1 Yes 3 No
c. Bred dairy heifers
1 Yes 3 No
d. Fresh dairy heifers
1 Yes 3 No
e. Lactating dairy cows
1 Yes 3 No
d0301
d0302
d0303
d0304
d0305
f. Dry dairy cows
1 Yes 3 No
g. Beef cows, bulls, steers, heifers
1 Yes 3 No
h. Dairy bulls
1 Yes 3 No
d0306
d0307
d0308
2. Please describe all movements of cattle onto this premises beginning with the start of the 30-day
reference period.
(Answer all columns for each movement. If more space is needed, please use the continuation table
at the end of the questionnaire.)
Date of movement
(mm/dd/yy)
Cattle class/type
Number of
head
Origin
(premises/farm name, city, state)
d0309a
__________________________
d0309b
d0309c
d0309d
d0310a
__________________________
d0310b
d0310c
d0310d
April 12, 2024
Interviewer Notes - General Comments & Questions D.17.a.- E.2.
13
d0311a
__________________________
d0311b
d0311c
d0311d
d0312a
__________________________
d0312b
d0312c
d0312d
d0313a
__________________________
d0313b
d0313c
d0313d
[Go To Continuation Table]
Click to go to Continuation Table
3. Were animals of the following cattle classes removed from the premises during the 30-day
reference period or since clinical signs were first observed? [Answer both columns.]
Removed from the
premises during the 30day reference period?
Cattle class
Removed from the
premises since clinical
signs were first
observed?
a. Preweaned dairy or beef calves
1 Yes 3 No
1 Yes 3 No
d0314
d0322
b. Weaned but not bred dairy heifers
1 Yes 3 No
1 Yes 3 No
d0315
d0323
c. Bred dairy heifers
1 Yes 3 No
1 Yes 3 No
d0316
d0324
d. Fresh dairy heifers
1 Yes 3 No
1 Yes 3 No
d0317
d0325
e. Lactating dairy cows
1 Yes 3 No
1 Yes 3 No
d0318
d0326
f. Dry dairy cows
1 Yes 3 No
1 Yes 3 No
d0319
d0327
g. Beef cows, bulls, steers, heifers
1 Yes 3 No
1 Yes 3 No
d0320
d0328
h. Dairy bulls
1 Yes 3 No
1 Yes 3 No
d0321
d0329
4. Please describe all movements of cattle off this premises beginning with the start of the 30-day
reference period.
(Answer all columns for each movement. If more space is needed, please use the continuation table
at the end of the questionnaire.)
April 12, 2024
Interviewer Notes - General Comments & Questions E.2.- 4.
14
Date of movement
(mm/dd/yy)
Cattle class/type
Number of
head
Destination
(premises/farm name, city, state)
d0330a
__________________________
d0330b
d0330c
d0330d
d0331a
__________________________
d0331b
d0331c
d0331d
d0332a
__________________________
d0332b
d0332c
d0332d
d0333a
__________________________
d0333b
d0333c
d0333d
d0334a
__________________________
d0334b
d0334c
d0334d
[Go To Continuation Table]
Click to go to Continuation Table
5. During the 30-day reference period, how often were the following types of cattle isolated (kept
physically separated) before being comingled with this operation’s cattle?
(Check NA if not applicable, i.e., did not have cattle return and/or join during the time frame.)
a. Cattle returning to the operation? .................... d0335 1 Always
2 Sometimes 3 Never 4 NA
b. New cattle joining the operation (permanently or temporarily)?
............................................................................. d0336 1 Always
2 Sometimes 3 Never 4 NA
[If Questions 5. a. and b. BOTH are Never or NA, go to Question 7.]
6. How many days were these types of cattle typically isolated?
(Check NA if not applicable, i.e., did not have cattle return and/or join during the time frame.)
a. Cattle returning to the operation? ................................................
d0337
# days
4 NA
# days
4 NA
b. New cattle joining the operation (permanently or temporarily)?
....................................................................................................d0338
7. During the 30-day reference period, did any cattle leave this operation for any purpose (e.g.,
veterinary clinic, show, sale, petting zoo, or similar) and then return to this operation?
................................................................................................................................ d0339
1 Yes
3 No
Section F – Operation Management
April 12, 2024
Interviewer Notes - General Comments & Questions E.4.- 7.
13
1. During the 30-day reference period, which of the following describes your standard colostrum
feeding practices for calves? [Check only one.] d0401
1 Unpasteurized cow colostrum from a single dam
2 Pasteurized cow colostrum from a single dam
3 Unpasteurized pooled cow colostrum
4 Pasteurized pooled cow colostrum
5 Commercial colostrum replacer
6 Calves are not fed colostrum
2. Which of the following liquid diets are calves fed prior to weaning? [Check all that apply.] d0402
a Medicated/Nonmedicated milk replacer
b Unpasteurized milk
c Pasteurized milk
d Acidified milk
e Other (specify:
d0402oth)
3. What are the water sources for cattle?
a. Off-site fresh water (e.g., municipal, community, commercial) ..................... d0403
1 Yes 3 No
b. Well ............................................................................................................... d0404
1 Yes 3 No
c.
1 Yes 3 No
Surface water (e.g., pond, canal)................................................................... d0405
d. Other (specify:
d0406oth)
............... d0406
1 Yes 3 No
4. Are water treatments (e.g., chlorination) used in the drinking water for the cattle on this operation?
....................................................................................................................... d0407
a. If Yes, are these treatments conducted: ...................... d0408
1 Yes 3 No
1 Continuously? 3 Intermittently?
5. During the 30-day reference period, which best describes how frequently the water delivery
systems (e.g., water tank or trough, waterer) were drained and cleaned? [Check only one.] d0409
1 Daily 2 Weekly 3 2-3 times per month 4 Never
For the next two questions, “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.
6. During the 30-day reference period, how often were wild birds observed in/around sources from
which the cows drink? [Check only one.] d0410
1 Always 2 Most of the time 3 Sometimes 4 Never
7. Where are feed rations fed at this dairy being mixed? [Check only one.]
........................................................................ d0411 1 At this dairy
2 At a location off-site 3 Both
8. Do feed components include:
April 12, 2024
Interviewer Notes - General Comments & Questions F.1.- 8.a.
14
a. Feather/other poultry meal ....................................................... d0412
April 12, 2024
1
Yes
3
Interviewer Notes - General Comments & Questions F.1.- 8.a.
No
4
Don’t Know
14
b. Poultry litter/manure .................................................................. d0413 1 Yes
3 No 4 Don’t Know
c. Other poultry byproducts ........................................................... d0414 1 Yes
3 No 4 Don’t Know
(1). If Yes, specify:
d0415oth
9. During the 30-day reference period, how frequently were wild birds, wild animals, and rodents able
to access cattle feed or feed ingredients (e.g., feed spillage, open bag, cover left open, feedline,
commodity bays)? For the next two questions, “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.
Always
Most of the
time
Sometimes
Never
a. Large birds (e.g., waterfowl such
as ducks and geese, raptors such
as hawks) d0416
1
2
3
4
b. Small birds (e.g., finches,
sparrows, starlings, pigeons,
blackbirds, grackles, cowbirds)
1
2
3
4
Wild animals (e.g., raccoons,
opossums, coyotes, feral swine,
deer, rabbits, foxes) d0418
1
2
3
4
d. Rodents (e.g., rats, mice, squirrels,
gophers) d0419
1
2
3
4
Animal type
d0417
c.
10. During the 30-day reference period, did this operation ever transport cattle in trucks and/or trailers
shared with other livestock operations? ................................................................ d0420 1 Yes
3 No
[If No, go to Question 13.]
11. Were shared trucks or trailers cleaned prior to use? ............................................. d0421
1 Yes 3 No
12. Which of the following best describes the cleaning procedures? [Check only one.] d0422
1 Wash vehicle with water or steam only
2 Chemically disinfect only
3 Wash vehicle and chemically disinfect
4 Other (specify:
d0422oth)
13. During the 30-day reference period, did this operation ever use the same equipment to handle
manure and feed? .................................................................................................. d0423 1 Yes
3 No
[If No, go to Question 17.]
14. Were separate buckets used to handle manure and feed? .................................. d0424
1 Yes 3 No
15. Was equipment (excluding separate buckets) cleaned between use for manure and use for feed?
April 12, 2024
Interviewer Notes - General Comments & Questions F.8.b.- 15.
15
................................................................................................................................ d0425
April 12, 2024
Interviewer Notes - General Comments & Questions F.8.b.- 15.
Yes
1
3
No
15
16. If Yes to Question 15, which of the following best describes the cleaning procedures? [Check only one.] d0426
1 Wash equipment with water or steam only
2 Chemically disinfect only
3 Wash equipment and chemically disinfect
4 Other (specify:
d0426oth)
17. What kind(s) of bedding are used on this dairy? [Check all that apply.] d0427
a Wood shavings and/or sawdust
b Straw and/or hay
c Sand
d Rice hulls
e Paper
f Compost and/or dried manure
g Rubber mats/mattress
h Other (specify:
d0427oth)
18. Prior to use, is fresh bedding accessible to:
a. Wild birds ....................................................................................................... d0428
1 Yes 3 No
b. Wild animals (e.g., raccoons, opossum, coyotes, foxes)............................... d0429
1 Yes 3 No
c.
1 Yes 3 No
Domestic animals (e.g., dogs, cats)............................................................... d0430
19. What type of water is used to flush the alleys? [Check all that apply.] d0431
a Lagoon or recycled flush water
b Surface pond water
c Municipal water
d Well water
e None
f Other (specify:
d0431oth)
20. During the 30-day reference period or since clinical signs were first observed, was manure on
this operation: [Answer both columns.]
30-day reference period
a. Stored on premises?
b. Composted for bedding?
April 12, 2024
Since clinical signs were
first observed
1 Yes 3 No
1 Yes 3 No
d0432
d0436
1 Yes 3 No
1 Yes 3 No
d0433
d0437
Interviewer Notes - General Comments & Questions F.16.- 20.b.
16
c. Applied to land managed by this
premises?
1 Yes 3 No
1 Yes 3 No
d0434
d0438
d. Removed, sold, or given away?
1 Yes 3 No
1 Yes 3 No
d0435
d0439
21. During the 30-day reference period, was manure or used bedding from other premises brought onto
this operation? .............................................................................. d0440 1 Yes
3 No 4 Don’t Know
Questions 22–26 refer to persons such as the producer, employees, farm help, crews, or similar.
22. What is the total number of employees working on this operation that have access to or directly work
with the cattle (including family, both paid and unpaid)? ....................................... d0441
#
23. During the 30-day reference period, did any workers on this operation visit another dairy premises?
...................................................................................................... d0442 1 Yes
3 No 4 Don’t know
24. During the 30-day reference period, did any workers on this operation visit livestock shows or 4-H
events? ......................................................................................... d0443 1 Yes
3 No 4 Don’t know
25. Are any workers or members of their households employed by any of the following:
a. Workers
b. Members of
household
Other dairy
operations?
Swine farms?
Poultry farms?
Other livestock
operations?
1 Yes 3 No
4 Don’t know
1 Yes 3 No
4 Don’t know
1 Yes 3 No
4 Don’t know
1 Yes 3 No
4 Don’t know
d0444
d0446
d0448
d0450
1 Yes 3 No
4 Don’t know
1 Yes 3 No
4 Don’t know
1 Yes 3 No
4 Don’t know
1 Yes 3 No
4 Don’t know
d0445
d0447
d0449
d0451
26. Do any employees own their own livestock and/or poultry, including small backyard herds/flocks?
...................................................................................................... d0452 1 Yes
3 No 4 Don’t know
27. During the 30-day reference period, did any of the following types of people visit this operation?
If Yes, how many times did they visit and did they have physical contact with the cattle?
Did they visit the
operation?
(If Yes, answer next
two columns)
Visitor type
a. Veterinarian
1 Yes 3 No
b. Nutritionist or feed consultant
1 Yes 3 No
c.
1 Yes 3 No
Breeding technician
April 12, 2024
d0453
d0454
d0455
If Yes,
How many times
did they visit?
Did this visitor have
physical contact
with cattle?
1 Yes 3 No
d0453a
d0453b
1 Yes 3 No
d0454a
d0454b
1 Yes 3 No
d0455a
Interviewer Notes - General Comments & Questions F.20.c.-27.c.
d0455b
17
d. Feed or feed ingredient
delivery personnel
1 Yes 3 No
e. Milk hauler
1 Yes 3 No
f.
1 Yes 3 No
d0456
d0457
Contract hauler driver or
vehicle (e.g., cattle, manure)
d0458
d0456b
1 Yes 3 No
d0457a
d0457b
1 Yes 3 No
d0458a
d0458b
1 Yes 3 No
g. Renderer
d0459
h.
Hoof trimmer
i.
Other
(specify:
1 Yes 3 No
d0459a
d0459b
1 Yes 3 No
d0460
)
1 Yes 3 No
)
1 Yes 3 No
d0461oth
j.
1 Yes 3 No
d0456a
Other
(specify:
d0462oth
d0461
d0462
1 Yes 3 No
d0460a
d0460b
1 Yes 3 No
d0461a
d0461b
1 Yes 3 No
d0462a
d0462b
28. During the 30-day reference period, was a washroom with running water and soap available in the
milking barn? ...................................................................... d0463 1 Always
2 Sometimes 3 Never
Section G – Environmental Factors & Wild Birds
1. Are the following water body types visible or within 350 yards (about three football fields) of this
operation?
a. Pond or lake ..................................................................................................... d0501
1 Yes 3 No
b. Stream or river ................................................................................................. d0502
1 Yes 3 No
c.
Wetland or swamp ........................................................................................... d0503
1 Yes 3 No
d. Wastewater lagoon .......................................................................................... d0504
1 Yes 3 No
e. Standing water during the 30-day reference period ...................................... d0505
1 Yes 3 No
f.
1 Yes 3 No
Water ditch or canal ......................................................................................... d0506
g. Other (specify:
d0507oth)
.......... d0507
1 Yes 3 No
[If Question 1.a. through g. are all No, go to Question 3.]
2. For those water bodies, including drainage ditches and lagoons within 350 yards of the operation,
approximately how many wild waterfowl or shorebirds (e.g., ducks, geese, wading birds, gulls) were
seen on the water during the 30-day reference period? [Check only one.] d0508
1 None 2 Tens 3 Hundreds 4 Thousands 5 Don’t know
3. What is the approximate distance (in yards) to the closest field where crops or hay are harvested?
[Check only one.] d0509
1 50 yards or less 2 51–100 yards 3 101–350 yards 4 351 yards or more
April 12, 2024
Interviewer Notes - General Comments & Questions F.20.d.- G.3.
18
4. For this closest field, approximately how many wild waterfowl or shorebirds (e.g., ducks, geese,
wading birds, gulls) were seen during the 30-day reference period? [Check only one.] d0510
1 None 2 Tens 3 Hundreds 4 Thousands 5 Don’t know
5. During the 30-day reference period, how frequently were the following types of wild birds seen on
the operation and within 100 yards of the cattle?
For this question, “Often” is 51–100% of the time, “Sometimes” is 1–50% of the time, and “Never” is
0% of the time.
Often
Sometimes
Never
1
2
3
b. Gulls d0512
1
2
3
c.
1
2
3
d. Pigeons and doves d0514
1
2
3
e. Blackbirds, crows, cowbirds,
grackles d0515
1
2
3
f.
Small perching birds (e.g.,
sparrows, starlings, swallows) d0516
1
2
3
g. Wild turkeys, pheasants, quail d0517
1
2
3
h. Raptors (e.g., eagles, hawks, owls,
vultures) d0518
1
2
3
1
2
3
Bird type
a. Waterfowl (e.g., ducks, geese)
d0511
i.
Other water birds (e.g., egrets,
cormorants) d0513
Other d0519
(specify:
)
d0519oth
6. During the 30-day reference period, did you or other farm workers observe any sick or dead wild
birds on the premises? ........................................................................................ d0520 1 Yes
3 No
[If No, go to Question 7.]
a. Specify the type(s) of sick or dead birds:
d0521oth
b. Were any sick or dead birds tested for HPAI? ......................... d0522
1 Yes 3 No 4 Don’t Know
(1) If Yes to Question 6.b., were any positive?......................... d0523
1 Yes 3 No 4 Don’t Know
7. During the 30-day reference period, how often were the following wild animals, or evidence of their
presence, seen on the premises?
April 12, 2024
Interviewer Notes - General Comments & Questions G.4.- 7.
19
For this question, “Often” is 51–100% of the time, “Sometimes” is 1–50% of the time, and “Never” is
0% of the time.
a. Wild mammals (e.g., raccoons, opossum, coyotes, foxes)
..................................................................................... d0524 1 Always
b. Rodents (e.g., rats, mice, squirrels, gophers).............. d0525
2 Sometimes 3 Never
1 Always 2 Sometimes 3 Never
8. Does this premises have a written wildlife management plan that includes methods to minimize
wildlife or wild bird entry and reduce wildlife attractants such as standing water?
.............................................................................................................................. d0526
1 Yes
3 No
Comments Section
Please use this section for anything else you would like to add. For example, how do you think HPAI
was/is spreading on your operation or in the geographic area? Is there something about your operation or
your experience with this syndrome that you would like to share? d0601
Please attach any additional information you think would be valuable to this investigation, such as
laboratory results prior to syndrome diagnosis, a site map with impacted pens labeled, full ration
ingredient list, milk production records, hospital records, or the number of cows impacted per day.
April 12, 2024
Interviewer Notes - General Comments & Questions G.7.- 8.
20
Section B, Question 8.b. Continuation Table
Date clinical signs
were first observed in
the pen (mm/dd/yy)
Pen number
Pen average
days in milk
Cattle class
d0080a
d0080b
_______________________________________
d0080c
d0080d
d0081a
d0081b
_______________________________________
d0081c
d0081d
d0082a
d0082b
_______________________________________
d0082c
d0082d
d0083a
d0083b
_______________________________________
d0083c
d0083d
d0084a
d0084b
_______________________________________
d0084c
d0084d
[Return
8.c.]
ClicktotoSection
returnB,
toQuestion
Section B
Section E, Question 2. Continuation Table
Date of movement
(mm/dd/yy)
Cattle class/type
Number of
head
Origin
(premises/farm name, city, state)
d0350a
__________________________
d0350b
d0350c
d0350d
d0351a
__________________________
d0351b
d0351c
d0351d
d0352a
__________________________
d0352b
d0352c
d0352d
d0353a
__________________________
d0353b
d0353c
d0353d
d0354a
__________________________
d0354b
d0354c
d0354d
April 12, 2024
Interviewer Notes - General Comments & Questions B.8.b & E.2.
21
d0355a
__________________________
d0355b
d0355c
d0355d
[Return
ClicktotoSection
return E,
to Question
Section E3.]
Section E, Question 4. Continuation Table
Date of movement
(mm/dd/yy)
Cattle class/type
Number of
head
Destination
(premises/farm name, city, state)
d0360a
__________________________
d0360b
d0360c
d0360d
d0361a
__________________________
d0361b
d0361c
d0361d
d0362a
__________________________
d0362b
d0362c
d0362d
d0363a
__________________________
d0363b
d0363c
d0363d
d0364a
__________________________
d0364b
d0364c
d0364d
d0365a
__________________________
d0365b
d0365c
d0365d
[Return
to return
SectiontoE,Section
Question
Click to
E 5.]
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April 12, 2024
Interviewer Notes - General Comments & Questions E.2.& 4.
22
| File Type | application/pdf |
| Author | Neshelaar, Wilhelm - MRP-APHIS |
| File Modified | 2024-06-20 |
| File Created | 2024-06-20 |