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, or > 5/1000 for 1 day.
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 (Dead + Culls) as x/1000

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.

Today

Yesterday

2 Days Before

Method by which notified of mortality increase

Through visitation

Through communication with grower

Date Notified

Was notification immediate as required in contract?

Grower was retrained on mortality reporting requirements

Other corrective action was implemented, please describe

Are birds greater than 21 days of age?

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

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

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

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

Date communicated

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 Sign-off and Date

Enter Name:

Enter Date & Time:

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.

Select VET
Vet Review Date:

Prescription

For Vet Use ONLY.

Prescription Number

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Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.