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pdfOMB Control No. 0648-0178; Expiration Date: 3/31/2020
marinE mammaL Human intEraction REPORT
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Exam Information (fill in or circle most appropriate)
Field #: ____________________________________
Species: _________________________________
Examiner: __________________________________
Recorder: ________________________________
Date of exam:_______________________________
Condition code (at exam): 1
Preservation: alive fresh
frozen
frozen/thawed
Body condition: emaciated
Documentation:
print
slide
Image disposition:__________________________
Integument :
digital
normal
abnormal
video
decomposed
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3
CBD
not emaciated
CBD
% Skin missing: <10% 10-25% 25-50% >50%
Explanation of terms:
YES = I have examined the area and/or found signs of this pathology, natural marking, or human interaction
NO = I have examined the area and/or did not find signs of this pathology, natural marking, or human interaction
CBD = I have examined the area and could not determine whether there were signs of human interaction (i.e. the
part was missing, degraded, or signs were ambiguous)
NE = I did not examine the area
NA = this animal doesn’t normally have that part (i.e. seals have no dorsal, dolphins have no rear flippers)
WHOLE BODY EXAM
YES
NO
CBD
NE
NA
Image taken
8 External pathology (pox, tattoo lesion, abscess, fungal patches)
9 Natural markings (scars, tooth rakes, unusual pigmentation)
10 Appendage(s) removed / Mutilation (with instrument)
11 Pelt removed / Mutilation (with instrument)
12 Body sliced / Mutilation
(with instrument)
13 Gear / Debris present on animal (including tags)
14 Gear / Debris retained (name & contact info in Comments)
15 HI lesions
(fishery, gunshot, propeller, healed HI scar, brand)
16 Predation / scavenger damage (circle all anatomical areas where damage hinders evaluation; numbers coincide
with anatomical areas below ):
17 18 19 20 21 22 23 24 25 26 27 28 29 NONE
FILL IN TABLE FOR ALL POSSIBLE FINDINGS OF HI
Image taken?
Other / CBD
Gunshot
Propeller
Other / CBD
Packing Band
Hook
MO/MU/CBD*
Net
Other / CBD
Abrasion
NE/NA
Impression/
Laceration
Penetrating
wound
Healed HI
scar
CBD
NO
DETAILED EXAM OF
ANATOMICAL AREAS
YES
Origin of Lesion
Gear- Line Gear/Debris
Other
Type of Lesion
Twine / line
Do not use for natural markings/pathology.
17 Rostrum/snout
18 Mandible
19 Head and/or neck
20 L Front appendage
21 R Front appendage
22 L Body
23 R Body
24 Dorsum/dorsal fin
25 Ventrum
26 Peduncle
27 L Rear appendage
28 R Rear appendage
29 Flukes/tail
* If Gear-Line is the lesion origin, mark the MO/MU/CBD column: "MO" for monofilament, "MU" for multifilament, and "CBD" if the type of line cannot be determined.
NOAA Form 89-864; OMB Control No.0648-0178; Expiration Date 03/31/2020
IFAW & VAQS (2012)
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Internal exam conducted
Bruising/blunt trauma
Skeleton examined
Broken bones present
Mouth/GI tract examined
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Lungs/bronchi examined
Lung/bronchi contents
Bullet/projectile found
Other lesions noted
Detailed Info
Image
taken
CBD
Date ____________
Partial
INTERNAL EXAM
YES
NO
Field #:______________________
(circle all that apply)
Details in Comments section -use line number
Details in Comments section -use line number
Details in Comments section -use line number
Associated tissue reaction: YES
NO
CBD
intact prey
partially digested
hard parts only
debris/gear
empty
other
Details in Comments section -use line number
(circle contents)
froth
fluid
found using: CT
air
(color:
X-ray dissection (collected? Y
N )
)
Details in Comments section -use line number
39 Comments (note line number from left margin before each comment):
40 Findings of Human Interaction:
(transfer to Level A Datasheet)
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Type
□YES □NO □CBD
(Exam Type: external__ internal___ both ___)
of HI: (provide details in comments)
□ Entanglement (gear__ debris__ CBD__)
□ Vessel trauma (sharp__ blunt__ both__ )
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□ Mutilation
Hooking (recreational__ commercial__ CBD__) □ Gunshot
□ Ingestion (gear__ debris__ CBD__)
□ Harassment
□CBD/Other_________
42 Stranding
Event History/Circumstances:
43 INITIAL
HumAN INTErACTION EvALuATION: If you marked YES above (line 40) evaluate
the external exam, necropsy, carcass condition and circumstances surrounding the stranding
event to answer the question below. Remember to be conservative in your subjective evaluation.
What is the likelihood that the finding of human interaction (line 40), contributed to
the stranding event?
0: Uncertain (CBD)
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Justification:
1: Improbable
2: Suspect
3: Probable
Final human interaction evaluation requires additional data from level B and C analyses
as well as review by experts (e.g. a veterinary pathologist)
PAPERWORK REDUCTION ACT INFORMATION
PUBLIC REPORTING BURDEN FOR THE COLLECTION OF INFORMATION IS ESTIMATED TO AVERAGE 45 MINUTES 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. SEND COMMENTS REGARDING THIS BURDEN ESTIMATE OR ANY OTHER ASPECT OF THE COLLECTION
INFORMATION, INCLUDING SUGGESTIONS FOR REDUCING THE BURDEN TO: CHIEF, MARINE MAMMAL AND SEA TURTLE CONSERVATION DIVISION,
OFFICE OF PROTECTED RESOURCES, NOAA FISHERIES, 1315 EAST-WEST HIGHWAY, SILVER SPRING, MARYLAND 20910. NOT WITHSTANDING ANY OTHER
PROVISION OF THE LAW, NO PERSON IS REQUIRED TO RESPOND, NOR SHALL ANY PERSON BE SUBJECTED TO A PENALTY FOR FAILURE TO COMPLY WITH,
A COLLECTION OF INFORMATION SUBJECT TO THE REQUIREMENTS OF THE PAPERWORK REDUCTION ACT, UNLESS THE COLLECTION OF INFORMATION
DISPLAYS A CURRENTLY VALID OFFICE OF MANAGEMENT AND BUDGET (OMB) CONTROL NUMBER.
NOAA Form 89-864; OMB Control No.0648-0178; Expiration Date 03/31/2020
IFAW & VAQS (2012)
File Type | application/pdf |
File Title | Protocol for Examining Marine Mammals for Signs of Human Interaction |
Subject | MMHSRP, Marine Mammals, Human Interaction, Level A |
Author | NOAA Fisheries |
File Modified | 2017-03-30 |
File Created | 2013-05-24 |