UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE VETERINARY SERVICES |
TUBERCULIN TEST RECORD (Special) |
||||||||||||||||||||||||||
HERD OWNER – LAST NAME FIRST NAME MIDDLE INITIAL |
REASON FOR CFT OR SCT |
DATE INJECTED |
CFT OR SCT TEST |
||||||||||||||||||||||||
1 AREA
|
|
6 HERD RETEST |
|
CFT OR SCT |
COMPARATIVE CERVICAL |
COMPLETE HERD TEST OF ALL ELIGIBLE ANIMALS |
NO. OF ELIGIBLE ANIMALS IN HERD |
||||||||||||||||||||
ROUTE – STREET – ROAD
|
RETEST OF CFT/SCT SUSPECTS YES NO |
YES NO IF NO |
|||||||||||||||||||||||||
2 HERD (RE) ACCREDITIATION |
|
7 TRACING REG. KILL |
|
COMPARATIVE RETEST 1st 2nd |
|||||||||||||||||||||||
3 MILK ORDINANCE |
|
8 TRACING REACTORS |
|
CC TEST RESULTS |
KIND OF HERD DEER ELK CATTLE BISON OTHER________ |
||||||||||||||||||||||
NEG |
SUS |
REA |
TOTAL |
||||||||||||||||||||||||
Post office STATE (Including ZIP Code) |
|||||||||||||||||||||||||||
4 sale – show |
|
9 Tracing exposed |
|
TUBERCULIN |
SERIAL NO. |
LICENSE NO. |
LOCATION OF CC TEST
RIGHT SIDE OF NECK
LEFT SIDE OF NECK |
||||||||||||||||||||
AVIAN |
|
|
|||||||||||||||||||||||||
COUNTY
|
TOWNSHIP |
SECTION |
HERD NO. |
5 IMPORTED
|
|
10 OTHER
|
|
||||||||||||||||||||
MAMMALIAN
|
|
|
|||||||||||||||||||||||||
ANIMAL NUMBER |
OFFICIAL IDENTIFICATION NUMBER
|
OTHER IDENTIFICATION |
AGE |
BREED |
SEX |
AVIAN PPD (UPPER) |
BOVINE PPD (LOWER) |
PREVIOUS CFT OR SCT RESPONSE |
CLASSIFI - CATION (CC TEST) (N S R) |
REACTOR TAG NUMBER |
REMARKS |
||||||||||||||||
SKIN THICKNESS |
Milli- Meters
Increase |
SKIN THICKNESS |
Milli- Meters
Increase |
||||||||||||||||||||||||
Milli- Meters
Normal |
Milli- Meters
72 Hours |
Milli- Meters
Normal |
Milli- Meters
72 Hours |
||||||||||||||||||||||||
1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
2 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
3 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
4 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
5 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
6 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
7 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
8 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
9 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
10 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
11 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
12 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
13 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
14 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
15 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
Signature
|
Title |
Date |
|||||||||||||||||||||||||
VS FORM 6-22C (Previous editions are obsolete.)
DEC 2009
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0146. The time required to complete this information collection is estimated to average .42 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. |
OMB APPROVED 0579-0146 EXP. DATE XX/XX/XXXX |
Reverse
6-22C
DEC 2009
| File Type | application/msword |
| File Title | UNITED STATES DEPARTMENT OF AGRICULTURE |
| Author | smharris |
| Last Modified By | Hardy, Kimberly A - APHIS |
| File Modified | 2013-01-30 |
| File Created | 2009-12-29 |