VS 17-36 Inspection Report of Establishment for Immediate Slaught

Clear Form
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 05790040. The time required to complete this information collection is estimated to average .5 hours 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.

OMB Approved
0579-0040
EXP. 09/2027

INSPECTION REPORT OF ESTABLISHMENT
FOR IMMEDIATE SLAUGHTER IMPORT
ANIMALS

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

INSPECTION REPORT
1. REPORT TYPE

2. DATE OF INSPECTION

3. LIVESTOCK COUNTRY OF ORIGIN

INITIAL INSPECTION
REINSPECTION
4. NAME OF ESTABLISHMENT
5. MAILING ADDRESS
6. PHYSICAL ADDRESS (if different than mailing)

7. ESTABLISHMENT PHONE NUMBER

8. ADMINISTRATOR/MANAGER (print name)

9. EMAIL ADDRESS

10. FACILITY POINT OF CONTACT (print name)

11. EMAIL ADDRESS

12. FEDERAL ESTABLISHMENT NUMBER

13. STATE ESTABLISHMENT NUMBER

14. TYPE OF CARRIER TO BE USED
TRUCK

OTHER

15. DOES CHUTE EXIST TO UNLOAD DIRECTLY INTO DESIGNATED PENS AT ESTABLISHMENT?
YES

NO (explain in block 26)

16. NUMBER AND MARKINGS OF DESIGNATED PENS
17. SPECIES OF ANIMAL TO BE IMPORTED
BISON

CATTLE

CERVID

GOAT

SHEEP

SWINE

WATER BUFFALO

YAK

OTHER

18. EMPLOYEE(S) DESIGNATED TO BREAK SEALS
FULL NAME

POSITION

FULL NAME

POSITION

FULL NAME

POSITION

FULL NAME

POSITION

19. NAME OF FSIS INSPECTOR/VETERINARIAN (print name)

20. SIGNATURE OF FSIS INSPECTOR/VETERINARIAN
FOR MEXICO ONLY

21. DO FACILITIES EXIST AT ESTABLISHMENT FOR CLEANING AND DISINFECTION OF CARRIER AFTER UNLOADING?
YES

NO (provide location of C&D in block 27)
INSPECTION REPORT

22. DATE OF LAST INSPECTION
23. ARE RESTRICTED ANIMALS HANDLED IN DESIGNATED PENS AS REQUIRED?
YES

NO (explain in block 28)

24. ARE PROVISIONS FOR BREAKING SEALS BEING FOLLOWED?
YES

NO (explain in block 29)

25. ARE WRITTEN RECORD AND REPORT REQUIREMENTS FOLLOWED?
A. All livestock (except swine) or carcasses are properly identified and verified by the export health certificate provided for the load, and carcasses can be connected to the
animal ID and importer/exporter, per the written procedure guide developed by the facility.
YES
NO (explain in block 30)
B. The facility maintains all records (i.e. weight tickets, sales slips, kill sheets, etc.) for 2 years for swine and 5 years for bovines, bison, sheep and goats, cervids, and
related ruminants.
YES
NO (explain in block 30)

VS FORM 17-36
OCT 2024

Previous Editions Obsolete

EXPLANATION (do not leave blank unless NA is selected)
26. IF “NO” IS CHECKED IN BLOCK 15 EXPLAIN WHY CHUTE DOES NOT EXIST TO UNLOAD DIRECTLY INTO DESIGNATED PENS AT ESTABLISHMENT.

NA

27. IF “NO” IS CHECKED IN BLOCK 21 PROVIDE LOCATION OF CLEANING AND DISINFECTION EQUIPMENT.

NA

28. IF “ NO” IS CHECKED IN BLOCK 23 EXPLAIN WHY RESTRICTED ANIMALS ARE NOT BEING HANDLED IN DESIGNATED PENS AS REQUIRED.

NA

29. IF “NO” IS CHECKED IN BLOCK 24 EXPLAIN WHY PROVISIONS FOR BREAKING SEALS WERE NOT FOLLOWED.

NA

30. IF “NO” IS CHECKED IN BLOCK 25 EXPLAIN WHY RECORD AND REPORT REQUIREMENTS WERE NOT FOLLOWED.

NA

A.
B.
NA

31. IF “NO” IS CHECKED IN BLOCK 38 EXPLAIN WHY ESTABLISHMENT IS NOT RECOMMENDED FOR APPROVAL.

STATEMENT

Establishment management has been advised of the responsibilities to provide for breaking seals, and agrees to the proper unloading, handling, and
verified/ reconciled identification of import animals until inspected and released by the assigned Government inspector. Establishment management
also agrees to slaughter or properly dispose of all livestock within 14 days of entry or will obtain permission from the Federal Animal Health Officials
before releasing any livestock other than imported livestock from the premises for any purpose.
32. RESPONSIBLE ESTABLISHMENT OFFICIAL

33. SIGNATURE OF ESTABLISHMENT OFFICIAL

34. DATE

36. SIGNATURE OF VS INSPECTOR COMPLETING REPORT

37. DATE

NAME
TITLE
35. PRINTED NAME OF VS INSPECTOR COMPLETING REPORT
38. RECOMMEND ESTABLISHMENT BE APPROVED

YES

NO (explain in block 31)
CERTIFICATION

This is to certify that the establishment has full-time veterinary supervision or oversight and should otherwise be approved to receive restricted import
animals for immediate slaughter.
39. PORT SERVICES VETERINARIAN (print name)

VS FORM 17-36
Reverse

40. PORT SERVICES VETERINARIAN (signature)

Previous editions obsolete

41. DATE

INSTRUCTIONS FOR VS FORM 17-36
INSPECTION REPORT OF ESTABLISHMENT FOR IMMEDIATE
SLAUGHTER IMPORT ANIMALS
BLOCKS 1-3: Inspection information.
BLOCKS 4-14: Establishment information.
BLOCK 15: If chute directly to pens does not exist, explain how flow of animals occurs
to prevent commingling of imported and domestic animals in block 26.
BLOCK 16: How are imported animal pens designated? Does not have to be
permanent designation but must prevent commingling of imported and domestic
animals. Must be able to segregate and hold animal(s) that require follow-up response
(ID issue, foreign animal disease issue, etc.).
BLOCK 17: Species to be imported, select all that apply. Write in species name after
OTHER if not specifically listed.
BLOCK 18: List of establishment employees designated and trained to break seals
and respond if there is an issue. If more than 4 employees are trained, additional
employees can be added as a separate addendum to this form. Only employees listed
may break seals on imported animals.
BLOCKS 19-20: FSIS inspector (printed name and signature).
BLOCK 21: Not applicable for Canadian imports.
BLOCK 22: Date last inspection was performed (not applicable for initial inspections).
BLOCK 23: Is establishment using pens in block 15 AND 16 above as prescribed?
BLOCK 24: Are trained employees verifying seals and checking required
paperwork for accuracy and completeness? Are issues with seals, paperwork, IDs,
FAD investigations, and unusual morbidity and mortality communicated to NBP
([email protected]) or the port of entry appropriately?
-

Seal and paperwork issues can be directed to the specific port of entry.
If issues arise after hours, animals can be unloaded and held separate
from other animals until issue is resolved. Establishment must still
attempt to contact port of entry and NBP.
Any ID, disease, transport, and other issues should be communicated to
NBP and other appropriate VS employees.

BLOCK 25 A: Confirm establishment is performing 100% ID verification on official ID
of all ruminant species, matching each animal’s ID to those listed on the Canadian
Export Health Certificate (CHC). Establishment must have a written SOP for the
process. Segregate and hold animal(s) with ID discrepancies and report to NBP at
[email protected] for resolution. In the email include scanned copy of CHC,
description of animal, and explanation of the problem.
Pictures are welcome but not mandatory. Animal(s) must be held until NBP releases
are obtained in writing. Remaining animals in the load can be released if IDs are
verified and all other requirements are met.
-

Immediate slaughter swine are not accompanied by a CHC; therefore, this
section does not apply to immediate slaughter swine.
If IDs are verified after slaughter, carcass and ALL parts must be held until
verified and released (this should be included in the establishment’s written
SOP).

BLOCK 25 B: Records maintained as required by description above.
BLOCKS 26-30: Explanation why requirements are not followed.
BLOCK 31: Explanation of why the establishment is not being recommended for
approval into the Port Services Immediate Slaughter Program.
BLOCK 32: Establishment responsible official (printed name and title).
BLOCK 33: Signature of responsible official.
BLOCK 34: Date of signature of establishment personnel obtained.
BLOCK 35: Printed name of VS inspector completing inspection/report.
BLOCK 36: Signature of VS inspector completing inspection/report.
BLOCK 37: Date of signature of VS inspector completing inspection/report.
BLOCK 38: Answer yes/no question - does the VS inspector recommend approval of
the establishment into the Port Services Immediate Slaughter Program?
BLOCK 39: Printed name of Port Services VMO processing the form.
BLOCK 40: Signature of Port Services VMO processing the form.
BLOCK 41: Date Port Services VMO processed the form.
Attachments included in separate documents:
Immediate Slaughter Program Flow Chart
Northern Border Ports Contact List