Flock Information Reporting Form

Download a blank fillable Flock Information Reporting Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Flock Information Reporting Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

FLOCK INFORMATION REPORTING FORM

VERSION 8.0

Producer/Enterprise Name

Producer Code/Quota/Premises ID Placement Date of Chicks/Poults

Barn #

Species

Category/Sex

Age of Birds

# Birds Placed

Birds Shipped

Mortality Rate (%)**

Kg/Bird

CFC OFFSAP/TFC OFFSP Certification:

Yes

Grow-out Density:

kg/m

lb/ft

kg/ft

space/bird

SECTION A - MEDICATION AND VACCINE INFORMATION

If Yes:

Were medications or vaccines administered at the hatchery?**

A through F*

Yes

Were vaccines administered on-farm?**

A through G*

Yes

Were any medications administered for treatment during the flock?**

A through H*

Yes

Were any non-treated diseases or syndromes diagnosed during the flock?**

Yes

Were any medications with a withdrawal time used in the last 14 days prior to

A through G*

Yes

shipment?

Were any extra-label medications used?**

A through F*

Yes

Were any Category I medications (e.g., ceftiofur - Excenel

, enrofloxacin – Baytril

)

A through G*

Yes

used on-farm in a preventive manner?

*Attach prescriptions for all extra-label medication use

**For mature turkeys, this information must be provided for the last 120 days of life.

RECORD ANY “YES” ANSWERS IN THE TABLE BELOW (USE THE GUIDE ABOVE TO FILL IN THE COLUMNS):

Question

(A)

(B)

(C)

(D)

(E)

(F)

(G)

(H)

# (i.e. 1-7

Medication or Vaccine

First

Last

Withdrawal

Safe

Dose

Route

Disease or Syndrome &

above)

Name

treatment

Period

Marketing

Flock Recovery Date

(i.e. feed, water,

date

(days)

Date (if any)

injection etc.)

SECTION B - FEED WITHDRAWAL AND LOADING INFORMATION

Planned catching time:

Actual start of catching:

Time

Planned processing time:

Time of last access to water:

Time

Yes

Was the feed supply disrupted in the last 48 hours?

Feed withdrawal time provided by processor:

Time

Time feed was no longer accessible:

Floor #1 Time

Floor #2 Time

Floor #3 Time

Additional Comments:

Provide any additional comments on flock condition during the brooding/grow-out period and/or the catching process on a separate sheet of paper if desired.

I confirm that, to the best of my knowledge, the information contained on this flock information reporting form is accurate and complete and that any diseases that were diagnosed

in the flock as a result of laboratory tests and/or readily observable clinical signs have been identified and reported on this form, and that I have followed required withdrawal times

as per the veterinary prescription, labeling indication and/or feed mill instructions.

CLEAR

SAVE

FORM

Producer’s Signature:

Note: This information is confidential between the producer and the processor.