BioSIRT INVESTIGATION FORM
Section 3 : Surveillance Questions
Case #: ……………………….. Page 1 of ……..Epidemiological information
Name, address, phone numbers of private or usual attending veterinarian.
What is the general health of the animals currently observed?
Post mortem comment on stock including number infected, extent, distribution and age of lesions.
Has there been any sickness on the Area of Interest (AOI) in the last 30 days?
If YES, the number and kind of stock, nature of disease, description of lesions, treatments used, number recovered or died and, if dead, how disposed of.
What is the disease history prior to this?
Has there been any sickness on adjoining AOIs?
If YES, please describe.
What vermin are on the AOI?
What wildlife or wild animals come onto or have access to the AOI?
What is the farm management type? (Hobby, commercial, intensive, broadacre, horticulture …
Section 3 : Surveillance Questions
Epidemiological information (continued)
What are this contact’s other premises? (Home, other enterprises, other of same enterprise …)
Do any employees have animals? (name, type, number, location of premises)
Is there any other stock at risk?
Has there been any sickness on the AOI in the last 30 days?
Have there been any recent overseas visitors? (Provide details of recent trips by owner, staff or visitors)
Are there any stock within 5km of the AOI boundary?
If YES, list names and addresses of those AOIs with stock.
What have been the general weather conditions on the AOI during the past 40 days? Include wind direction and velocity.
What is the owner’s opinion of the possibilities of origin?
What is the Veterinary Officer’s opinion of the possibilities of origin?
Any other comments?
Section 3 : Surveillance Questions
Epidemiological information (continued)
Insert question
Insert question
Insert question
Insert question
Insert question
Insert question
Insert question
Insert question
Insert question
Insert question
Insert question
|| LCC use: | Case #: ______| Entered date: .… / … / … | Entered by: ……………… | Checked by: ………………. |
BioSIRT Section 3: Surveillance Questions – Animals – V1 20/6/11 (INT11/42528)