One Health - RCA

• Version # 1: June 18, 2019

• Doc ID: 4.a.ii.2.a

• Farm Name

  Select

• House Number

• Age of Bird (In Days)

• Date Completed

  Date

• Requirements Statement:
  -For week 1 (0-7 days of age) action threshold is >5/1000/day for more than 2 consecutive days.
  -For week 2-harvest (8 days-harvest) action threshold is >3/1000/day for more than 2 consecutive days.

Requirements Statement: -For week 1 (0-7 days of age) action threshold is >5/1000/day for more than 2 consecutive days. -For week 2-harvest (8 days-harvest) action threshold is >3/1000/day for more than 2 consecutive days.

Chick Health

• Is This First Week Mortality?

  Yes

  No

• Chick Quality (0-7 Days)
  Select One Of The Following:

• Infectious Disease (Omphalitis, Asper, etc...)

• Non-Infectious Disease (Dehydration, Red Hocks, Navel)

• Mixed

• Other

• Describe:

Mortality as x/1000

• Increments of ".5" are only accepted. (As Needed)

• EX: 2.5 is okay, but 2.56 is NOT accepted.

• Today

• Yesterday

• 2 Days Before

• Comments (If Applicable)

On-Farm Issues

• Water

• Describe Issue:

• Temperature Extremes

• Describe The Issue:

• Air Quality

• Describe The Issue:

• Feed

• Describe The Issue:

• Lights

• Describe The Issue:

• Other

• Describe The Issue:

Correction

• Describe The Correction:

Infectious Disease

• Respiratory

• Select One Of The Following:

• Airsac

• Vaccine Reaction

• Other

• Describe The Issue:

Guts

• Select One Of The Following:

• Necrotic Enteritis

• Cocci

• Other

• Describe The Issue:

Lameness

• Select One Of The Following:

• Bacteria (FHN) (Synovitis)

• Reovirus

• Kinky Back

• Kick Stand

• Other

• Describe The Issue:

Other

• Dermatitis

• Mixed

• Uneven

• Spike

• Feed Knockdown

• Unknown

• Describe:

On Farm Necropsy

• Yes

  No

Submitted to Laboratory?

• Yes

  No

AI Swabs Submitted

• Yes

  No

Was a Feed Sample Submitted

• Yes

  No

Script Request

• Script Request Submitted?

  Yes

  No

• Tack A Picture Of Your Script Request Form

  Media

• Was This house Treated last flock?

  Yes

  No

• Is This The Second Flock In This House Being Treated?

  Yes

• Is This The Third Flock In This House Being Treated?

  Yes

• Is This The Fourth Flock In This House Being Treated?

  Yes

• Is This The Fifth Flock In This House Being Treated?

  Yes

• Is This More Than The Fifth Flock Being Treated In This House?

  Yes

Flock Supervisor Signature and Date

• Please Sign Below:

  Sign

Antibiotic Treatment (Details in Prescription)

• Penicillin

• Tetracycline

• Lincomycin

• Tylosin

• BMD

• SULFA

• Other

• Describe Treatment:

Non-Antibiotic Treatment (Run According to Label Directions Unless Instructed Otherwise By Vet)

• Amprol

• Copper Sulfate

• Manage

• Other

• Describe The Treatment

Management

• Cull Affected Birds

• Describe Alternative Management:

• Further Actions:

Reviewing Veterinarian Signature

• For VET use ONLY.

• Please Sign Below

  Sign

• For Vet Use ONLY.

• Prescription Number

• Add media

  Media