Title Page

  • Version # 1: June 18, 2019

  • Doc ID: 4.a.ii.2.a

  • Farm Name

  • House Number

  • Age of Bird (In Days)

  • Date Completed

  • 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.

Investigation Background

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?

  • 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)

Flock Supervisor Investigation

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

Submitted to Laboratory?

AI Swabs Submitted

Was a Feed Sample Submitted

Script Request

  • Script Request Submitted?

  • Tack A Picture Of Your Script Request Form

  • Was This house Treated last flock?

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

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

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

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

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

Flock Supervisor Signature and Date

  • Please Sign Below:

Veterinary Review Plan

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

Prescription

  • For Vet Use ONLY.

  • Prescription Number

  • Add media

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