Information

  • Farm Name

  • Grower Name

  • Street Address, State, Zip Code

  • Number of houses on contract

  • Number of houses on premise

  • Number of houses NOT in use

  • Conducted on

  • Conducted by:

  • Signature

AREA

[1] Disease history in the location and surroundings.

  • Last occurrence/s of the stated disease in a Mountaire and/or non-Mountaire site/premise (including this premise) in a 6-mile/10 kilometer radius?

  • 1.1. Avian Influenza (AI) in commercial poultry (chickens, turkeys, ducks, etc.) - Low pathogenicity or High pathogenicity?

  • 1.2. Avian Influenza in an avian species other than commercial (i.e. backyard flocks, waterfowl, pet birds, etc.)?

  • 1.3. Exotic ND or vvND in commercial poultry (chickens, turkeys, ducks, etc.)?

  • 1.4. Exotic ND or vvND in avian species other than commercial poultry?

  • 1.5. MG (gallisepticum) in commercial poultry (chickens, turkeys, ducks, etc.)?

  • 1.6. MS (synoviae) in commercial poultry (chickens, turkeys, ducks, etc.)?

  • 1.7. Infectious Coryza in commercial poultry (chickens, turkeys, ducks, etc.)?

  • 1.8. ILT in commercial poultry (chickens, turkeys, ducks, etc.)?

[2] Physical proximity of other poultry-related operations to this location.

  • Select the number of each of the types of sites/premises within a 1-mile radius of this premise.

  • 2.1. How many Mountaire broiler farms are within a 1 mile radius?

  • 2.2. How many non-Mountaire broiler farms within a 1 mile radius?

  • 2.3. How many Mountaire broiler breeder and/or pullet farms within a 1 mile radius?

  • 2.4. How many non-Mountaire broiler breeder and/or pullet farms within a 1 mile radius?

  • 2.5. How many table egg pullet farms or table egg layer farms are within a 1 mile radius?

  • 2.6. How many turkey farms within a 1 mile radius?

  • 2.7. How many backyard poultry/hobby poultry/fighting chickens within a 1 mile radius?

  • 2.8. How many poultry live auctions or flea markets within a 1 mile radius?

  • 2.9. Number of hog farms within a 1 mile radius?

  • 2.10. Number of litter processing sites within a 1 mile radius?

  • 2.11. Is there a rendering route within a 1 mile radius?

  • 2.12. Number of landfills within a 1 mile radius?

  • 2.13. Is there a preserve or natural site with waterfowl or wild birds within a 1 mile radius?

  • 2.14. Is there a non-Mountaire poultry company office within a 1 mile radius?

  • 2.15. Are there allied industries or poultry companies within a 1 mile radius?

  • 2.16.1 Number of Mountaire processing plant/s within a 1 mile radius?

  • 2.16.2 Number of Non-Mountaire processing plant/s within a 1 mile radius?

  • 2.17. Number of feed mill/s within a 1 mile radius?

  • 2.18. Number of hatchery/ies within a 1 mile radius?

PREMISE

Premise

  • A premise is a physical address containing the poultry growing operations. It boundaries are the perimeter buffer area (PBA), which is a functional zone surrounding the poultry houses and poultry raising area that separates them from areas unrelated to poultry production on that site and/or adjoining properties.

[1] Disease history on Premise.

  • Select the correct response with regard to the most recent disease outbreaks on this farm?

  • 1.1. Avian Influenza (AI) in commercial poultry (chickens, turkeys, ducks, etc.) - Low pathogenicity or High pathogenicity?

  • 1.2. Exotic ND or vvND (chickens, turkeys, ducks, etc.)?

  • 1.3. MG (gallisepticum) (chickens, turkeys, ducks, etc.)?

  • 1.4. MS (synoviae) (chickens, turkeys, ducks, etc.)?

  • 1.5. Fowl cholera (broilers, pullets, breeders)?

  • 1.6. Infectious Coryza (chickens, turkeys, ducks, etc.)?

  • 1.7. ILT (chickens, turkeys, ducks, etc.)?

[2] Physical aspects related to the operation of the location being audited.

  • With regard to the topics, select the one description which best describes the parts of this farm under the direct control of the caretaker.

  • 2.1. Warning sign at premise entrance?

  • 2.2. At premise entrance...

  • 2.3.1. Number of birds on premise?

  • 2.3.2. Number of birds on contract?

  • 2.3.3. Number of birds per house? (placed)

  • 2.4. Fencing

  • 2.5. Used litter storage

  • 5.8. Cleaning and disinfection program between flocks...

  • 2.6.1. Source of bird drinking water?

  • 2.6.2. Source of cool cell water?

  • 5.10. Water sanitation...

  • 2.7. Farms/Manure

  • 2.8.1. Machinery on Premise

  • 2.9.1 Equipment washing...

  • 2.10. Trash removal (i.e. dumpster)

  • 2.11. Vehicles from visitors...

  • 2.12. Premise vehicles...

[3] People that work on this premise performing poultry related tasks.

  • 3.1. Farm owners and/or main caretaker...

  • 3.2. Farm residence

  • 3.3. Farm labor is..

  • 3.4. Farm owners and/or main caretakers are...

  • 3.5. Farm laborers are...

  • 3.6. Multiple residences

[4] General management of the premise

  • 4.1.1 All-in / All-out (defined as a common downtime amongst all houses on a premise)

  • 4.1.2 All-in / All-out (defined as a common downtime amongst all houses on the contract)

  • 4.2. Location of dead bird disposal

  • 4.3. Type of dead bird disposal

  • 4.4 Does the farm often have to use a secondary bird disposal

HOUSE

[5] Physical aspects of the house

  • With regard to topics questioned, select the description which best describes the houses being audited.

  • 5.1. Visitor log is located...

  • 5.2. Visitor log is...

  • 5.3. Warning or biosecurity sign at house door...

  • 5.4. House doors when producer/employees in the house...

  • 5.5. House doors when no producer/employee in house...

  • 5.6. Bushes and/or high weeds around the house...

  • 5.7. Foot pan location...

  • 5.8. Foot pan condition...

  • 5.9. Control Room Cleanliness

[6] People that work in this location

  • With regard to topics questioned, select the description which best describes the houses being audited.

  • 6.1. Grower and/or farm manager clothing policy...

  • 6.2. Footwear for grower and/or farm manager...

  • 6.3. Caretaker/employee clothing policy...

  • 6.4. Footwear for caretaker/employee...

  • 6.5. Visitor dress policy...

[7] Other animals besides the commercial birds

  • With regard to topics questioned, select the description which best describes the houses being audited.

  • 7.1. Other livestock (non-poultry) having contact with chicken house(s)...

  • 7.2. Pets...

  • 7.3. Rodent control...

  • 7.4. Wild birds...

  • 7.5. Wild animals...

  • 7.5. Insects (flies and darkling beetles)...

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