Title Page

  • Version # 9: March 6, 2020

  • Doc ID: 4.a.ii.2.a

  • Notify Veterinarian of an initiated OHC

  • Date of RCA Submission

  • Farm Name

  • House Number

  • Date Placed

  • Number of Birds Placed

  • 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.

Flock Supervisor Investigation

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

  • 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?

  • Is this delayed reporting?

Reason for Delay:

  • Grower

  • Reporting not immediate as required by contract

  • Retrained for conformance

  • Other:

  • Describe

  • Flock Supervisor

  • Other:

  • Describe

  • 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...)

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

  • Mixed

  • Other

  • Describe:

  • 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...)

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

  • Mixed

  • Other

  • Describe:

Correction

  • Describe The Correction:

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

  • Please sign when complete

  • Is this delayed reporting?

Reason for Delay:

  • Grower

  • Reporting not immediate as required by contract

  • Retrained for conformance

  • Other:

  • Describe

  • Flock Supervisor

  • Other:

  • Describe

  • 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?

  • 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?

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

  • Respiratory

  • Select One Of The Following:

  • Airsac

  • Vaccine Reaction

  • ILT

  • Polyserositis

  • Other

  • Describe The Issue:

Guts

  • Select One Of The Following:

  • Necrotic Enteritis

  • Cocci

  • RSS

  • 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

  • Spike

  • Feed Knockdown

  • Unknown

  • Describe:

  • Comments (If Applicable)

  • 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?

  • 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?

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

  • Respiratory

  • Select One Of The Following:

  • Airsac

  • Vaccine Reaction

  • ILT

  • Polyserositis

  • Other

  • Describe The Issue:

Guts

  • Select One Of The Following:

  • Necrotic Enteritis

  • Cocci

  • RSS

  • 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

  • Spike

  • Feed Knockdown

  • Unknown

  • Describe:

  • Comments (If Applicable)

Correction

  • Describe The Correction:

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

  • Please sign when complete

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 / Maintain

  • Ioprin / Asperdine

  • Activo

  • CID Clean

  • Water Acidifier (PWT, SB Plus, Amacil)

  • Other

  • Describe The Treatment

Management

  • Cull Affected Birds

  • Describe Alternative Management:

  • Further Actions:

Reviewing Veterinarian Signature

  • For VET use ONLY.

  • Select VET

  • Delayed Review by Veterinarian

  • iAuditor Platform or Mobile Issue

  • Other

  • Vet Review Date:

Prescription

  • For Vet Use ONLY.

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

  • Notes:

  • Add media

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