Annex D - A1.2: Clinical and/or post-mortem signs observed in animals at an abattoir

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Name and Address of Abattoir:

Contact Name(s) for the Abattoir:

Contact Number(s) for the Abattoir:

Is this a federally registered establishment? Yes space / No space

If Yes:

  • What is the Establishment Number?
  • Who is the Veterinarian in Charge (VIC)?
  • Contact number(s) for VIC:

If No:

  • Record the Identification (Registration) number, if applicable:

Report received from: Dr./Mr./Mrs.

Occupation:

Telephone:

Date of Report: (yy/mm/dd) space / space/ space

Time of Report (24 hr):

Business Name and Address of premises of origin of suspect animals (including details of land location):

Contact number(s) for suspect premises:

Phone:
Cell:
Fax:

Contact Person/People for suspect premises (use back of page if more space is required):
Name (Indicate main Contact person) Phone Cell Fax Other

Type of premises:

Species affected:

The affected animals and / or carcasses are considered suspicious for the Regulated Animal Disease:

space

Description of the clinical signs and/or pathology and the clinical history (i.e. date that illness, production changes, etc. were first observed):

Have controls been instituted at the abattoir? Yes space / No space

If Yes:

  • Describe the controls

If No:

  • CFIA staff must ensure that proper controls have been put in place in the abattoir.
  • Complete Section A1.2.1

Have diagnostic samples been collected? Yes space / No space

If No:

  • CFIA staff must make arrangements for samples to be collected and submitted.
  • Complete Section A1.2.1

If Yes:

  • Have samples been submitted to the laboratory? Yes space / No space
    • If Yes:
      • Laboratory submission number(s):
    • If No:
      • CFIA staff must make arrangements for samples to be submitted.
      • Complete Sample Submission details at the end of Section A1.2.1

A1.2.1 Assessment at the abattoir: If the CFIA AH Veterinarian and/or other CFIA AH staff have to visit the Abattoir, the following section must be filled in.

CFIA Staff:

Date of Visit to the Abattoir: (yy/mm/dd) space / space / space

Time of Visit (24 hr):

Confirm Name and Address of Abattoir:

Confirm Contact Name(s) and Numbers for the Abattoir:

Confirm Owner Information and address of premises of origin of the suspect animals (including legal and description):

Confirm Species affected:

Confirm the clinical signs and/or pathology and the clinical history (i.e. date that illness, production changes, etc. were first observed):

Samples to be submitted to:

  • space Non-CFIA Laboratory space (Lab Name; Submission #)
  • and / or
  • space CFIA Laboratory space (Lab Name; Submission #)

Did you contact the CFIA Laboratory? Yes space / No space

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