One Health- RCA Current Version (14)

• Version # 14: February 7, 2022

• Doc ID: 4.a.ii.2.a

• Notify Veterinarian of an initiated OHC

  NOTIFY

• Date of RCA Submission

  Date

• Farm State

  Maryland

  Delaware

  Virginia

  North Carolina

  South Carolina

• Farm Name

  Select

• House Number(s)

• Date Placed

  Date

• Root Cause

  Select Dermatitis Necrotic Enteritis/Cocci Airsac/Polyserositis On-Farm Management Uneven Chick Mortality Other

  • Dermatitis
  • Necrotic Enteritis/Cocci
  • Airsac/Polyserositis
  • On-Farm Management
  • Uneven
  • Chick Mortality
  • Other

• Script Requested?

  Script Requested

  No Script Requested

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

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

Chick Health

• Increments of "0.1" - round to the tenth decimal place, are only accepted. (As Needed)

• EX: 2.3 is okay, but 2.28 is NOT accepted.

• Is This First Week Mortality?

  Yes

  No

• Is this delayed reporting?

  Yes

  No

Reason for Delay:

• Grower

• Reporting not immediate as required by contract

• Retrained for conformance

• Other:

• Describe

• Flock Supervisor

• Other:

• Describe

• Are you reporting multiple houses?

  Yes

  No

• House Number

• Number of Birds Placed in House

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in house

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

Chick Quality, Select Following:

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

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

  Yes

  No

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

  Yes

  No

• Mixed

  Yes

  No

• Other

• Describe:

• Are you reporting multiple houses?

  Yes

  No

• House Number

• Number of birds placed in the house:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of birds placed in the house:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• House Number:

• Birds placed in the house:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

Chick Quality, Select Following:

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

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

  Yes

  No

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

  Yes

  No

• Mixed

  Yes

  No

• Other

• Describe:

Correction

• Describe The Correction:

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

• Has a written and/or verbal instruction on administering medication occurred?

  Yes

  No

• Date communicated

  Date

• Are you treating more than one house?

  Yes

  No

• House number:

• Number of Birds Placed:

• Was the house treated last flock?

  Yes

  No

• Acceptable Values in this section are: 2, 3, or 4

• For example: House X was treated the last 2 flocks- making this the 3rd consecutive treatment. The next answer would be 3

• What consecutive treatment is this house on?

  2

  3

  4

• Treating a second house?

  Yes

  No

• House Number:

• Number of Birds Placed:

• Was the house treated last flock?

  Yes

  No

• Acceptable Values in this section are: 2, 3, or 4

• For example: House X was treated the last 2 flocks- making this the 3rd consecutive treatment. The next answer would be 3

• What consecutive treatment is this house on?

  2

  3

  4

• Treating a third house?

  Yes

  No

• House Number:

• Number of Birds Placed:

• Was the house treated last flock?

  Yes

  No

• Acceptable Values in this section are: 2, 3, or 4

• For example: House X was treated the last 2 flocks- making this the 3rd consecutive treatment. The next answer would be 3

• What consecutive treatment is this house on?

  2

  3

  4

• Treating a fourth house?

  Yes

  No

• House Number:

• Number of Birds Placed:

• Was this house treated last flock?

  Yes

  No

• Acceptable Values in this section are: 2, 3, or 4

• For example: House X was treated the last 2 flocks- making this the 3rd consecutive treatment. The next answer would be 3

• What consecutive treatment in this house on?

  2

  3

  4

• Treating a fifth house?

  Yes

  No

• House Number:

• Number of Birds Placed:

• Was this house treated last flock?

  Yes

  No

• Acceptable Values in this section are: 2, 3, or 4

• For example: House X was treated the last 2 flocks- making this the 3rd consecutive treatment. The next answer would be 3

• What consecutive treatment is this house on?

  2

  3

  4

• Treating a sixth house?

  Yes

  No

• House Number:

• Number of Birds Placed:

• Was this house treated last flock?

  Yes

  No

• Acceptable values in this section are: 2, 3, or 4

• For example: House X was treated the last 2 flocks- making this the 3rd consecutive treatment. The next answer would be 3

• What consecutive treatment is this house on?

  2

  3

  4

• House Number:

• Number of birds placed in the house

• Was this house treated last flock?

  Yes

  No

• Accepted values are: 2, 3, or 4

• For example: If House X was treated for the last 2 flocks, then this would be the 3rd consecutive treatment. The answer to the next question would be 3

• What consecutive treatment is this house on:

  2

  3

  4

Flock Supervisor Sign-off and Date

• Please sign when complete

  Sign

• Is this delayed reporting?

  Yes

  No

Reason for Delay:

• Grower

• Reporting not immediate as required by contract

• Retrained for conformance

• Other:

• Describe

• Flock Supervisor

• Other:

• Describe

• Are you reporting multiple houses?

  Yes

  No

• House Number

• Number of Birds Placed:

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of Birds Placed:

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of Birds Placed:

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of Birds Placed

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of Birds Placed:

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of Birds Placed:

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of Birds Placed:

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of Birds Placed:

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of Birds Placed:

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of Birds Placed:

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of Birds Placed:

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of Birds Placed:

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of Birds Placed:

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Number of Birds Placed:

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• House Number

• Number of Birds Placed:

• Age of birds at time of mortality increase:

• Mortality Day 1 (x/1000)

• Mortality Day 2 (x /1000)

• Mortality Day 3 (x /1000)

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

Swab Clarification

• Are birds greater than 21 days of age?

  Yes

  No

• Is the mortality (deads, NOT culls) greater than 3/1000 for 2 consecutive days or 5/1000 for 1 day?

  Yes

  No

• Will or have birds or AI swabs been submitted to the lab in response?

  Yes

  No

On-Farm Issues

• Water

• Describe Issue:

• Temperature Extremes

• Describe The Issue:

• Air Quality

• Describe The Issue:

• Feed

• Describe The Issue:

• Lights

• Describe The Issue:

• Catch Mortality

• Suffocation

• Culling

• Other

• Other

• Describe The Issue:

Infectious Disease

Guts

• Select One Of The Following:

• Necrotic Enteritis

• Cocci

• Describe: (Maxima or Tenella)

• RSS

• Other

• Describe The Issue:

Respiratory

• Select One Of The Following

• Airsac

• Is there a known/predisposing cause?

• Vaccine Reaction

• ILT

• Polyserositis (bacterial infection in multiple organs)

• Is there a known/predisposing cause?

• Pericarditis (bacterial infection around heart)

• Is there a known/predisposing cause?

• Other

• Describe the Issue:

Lameness

• Select One Of The Following:

• Bacteria (FHN) (Synovitis)

• Reovirus (Ruptured Tendons)

• Kinky Back

• Kick Stand

• Other

• Describe The Issue:

Other

• Dermatitis

• Mixed

• Uneven

• Eye Ulcers (AB eyes)

• Spike

• Feed Knockdown

• Unknown

• Describe:

• Comments (If Applicable)

• Are you reporting multiple houses?

  Yes

  No

• House Number

• Number of Birds Placed:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Do you wish to report another house?

  Yes

  No

• House number?

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

• Number of Birds Placed:

• Age of birds (in days) at time of submission:

• Mortality Today (x /1000)

• Mortality Yesterday (x /1000)

• Mortality 2 Days Ago (x /1000)

Swab Clarification

• Are birds greater than 21 days of age?

  Yes

  No

• Is the mortality (deads, NOT culls) greater than 3/1000 for 2 consecutive days or 5/1000 for 1 day?

  Yes

  No

• Will or have birds or AI swabs been submitted to the lab in response?

  Yes

  No

On-Farm Issues

• Water

• Describe Issue:

• Temperature Extremes

• Describe The Issue:

• Air Quality

• Describe The Issue:

• Feed

• Describe The Issue:

• Lights

• Describe The Issue:

• Catch Mortality

• Suffocation

• Culling

• Other

• Other

• Describe The Issue:

Infectious Disease

Guts

• Select One Of The Following:

• Necrotic Enteritis

• Cocci

• Describe: (Maxima or Tenella)

• RSS

• Other

• Describe The Issue:

Respiratory

• Select One Of The Following:

• Airsac

• Is there a known/predisposing cause?

• Vaccine Reaction

• ILT

• Polyserositis (Bacterial infections in multiple organs)

• Is there a known/predisposing cause?

• Pericarditis (Bacterial infection around heart)

• Is there a known/predisposing cause?

• Other

• Describe the Issue:

Lameness

• Select One Of The Following:

• Bacteria (FHN) (Synovitis)

• Reovirus (Ruptured Tendons)

• Kinky Back

• Kick Stand

• Other

• Describe The Issue:

Other

• Dermatitis

• Mixed

• Uneven

• Eye Ulcers (AB Eyes)

• Spike

• Feed Knockdown

• Unknown

• Describe:

• Comments (If Applicable)

Correction

• Describe The Correction:

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

• Has a written and/or verbal instruction on administering medication occurred?

  Yes

  No

• Date communicated

  Date

• Are you treating more than one house?

  Yes

  No

• House number:

• Number of Birds Placed:

• Was this house treated last flock?

  Yes

  No

• Acceptable answers in this section are : 2, 3, or 4

• Ex: If this house has been treated the last 2 flocks, this would be the 3rd consecutive treatment and you would select "3" below

• What Consecutive treatment is this?

  2

  3

  4

• Treating a second house?

  Yes

  No

• House Number:

• Number of Birds Placed:

• Was this house treated last flock?

  Yes

  No

• Acceptable answers in this section are : 2, 3, or 4

• Ex: If this house has been treated the last 2 flocks, this would be the 3rd consecutive treatment and you would select "3" below.

• What consecutive treatment is this?

  2

  3

  4

• Treating a third house?

  Yes

  No

• House Number:

• Number of Birds Placed:

• Was this house treated last flock?

  Yes

  No

• Acceptable answers in this section are: 2, 3, or 4

• Ex: If this house has been treated the last 2 flocks, this would be the 3rd consecutive treatment and you would select "3" below

• What consecutive treatment is this?

  2

  3

  4

• Treating a fourth house?

  Yes

  No

• House Number:

• Number of Birds Placed:

• Was this house treated last flock?

  Yes

  No

• Acceptable answers in this section are: 2, 3, or 4

• Ex: If this house has been treated the last 2 flocks, this would be the 3rd consecutive treatment and you would select "3" below

• What consecutive treatment is this?

  2

  3

  4

• Treating a fifth house?

  Yes

  No

• House Number:

• Number of Birds Placed:

• Was this house treated last flock?

  Yes

  No

• Acceptable answers in this section are: 2, 3, or 4

• Ex: If this house was treated the last 2 flocks, this would be the 3rd consecutive treatment and you would select "3" below

• What consecutive treatment is this?

  2

  3

  4

• Treating a sixth house?

  Yes

  No

• House Number:

• Number of Birds Placed

• Was this house treated last flock?

  Yes

  No

• Acceptable answers in this section are: 2, 3, or 4

• Ex: If this house was treated the last 2 flocks, this would be the 3rd consecutive treatment and you would select "3" below

• What consecutive treatment is this?

  2

  3

  4

• House Number:

• Number of Birds Placed:

• Was this house treated last flock?

  Yes

  No

• Acceptable answers in this section are: 2, 3, or 4

• Ex: If this house was treated for the last 2 flocks, this would be the 3rd consecutive treatment and you would select "3" below.

• What consecutive treatment is this?

  2

  3

  4

Flock Supervisor Sign-off and Date

• Please sign when complete

  Sign

Antibiotic Treatment (Details in Prescription)

• Penicillin

• Tetracycline

• Lincomycin

• Tylosin

• BMD

• SULFA (SDM, Sulmet)

• Other

• Describe Treatment:

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

• Amprol

• Copper Sulfate

• Manage / Maintain

• Ioprin / Asperdine

• Activo

• CID Clean

• Water Acidifier (PWT, SB Plus, Amacil)

• Celmanax

• Lumance

• Other

• Describe The Treatment

Management

• Cull Affected Birds

• Describe Alternative Management:

• Further Actions:

Reviewing Veterinarian Signature

• For VET use ONLY.

• Select VET

  Select

• Delayed Review by Veterinarian

  Yes

  No

• iAuditor Platform or Mobile Issue

• Other

• Vet Review Date:

  Sign

• For Vet Use ONLY.

• Script Completed (NOTE: Farm Name, House #, Date are the Title)

• Notes:

• Add media

  Media