Appendix A_Service Log Template

SERVICE DATE SERVICE PROVIDED
EX. 4/5/2010
EX. 4/6/2010
EX. 4/6/2010
EX. 4/7/2010

1

pregnancy check
dystocia
vaccinations
4-H presentation

SPECIES SERVED
dairy
dairy
goat
dairy, goat

SERVICE/APPOINTMENT
DURATION (h)
2
1
1.5
1

CLIENT/FARM SERVICED LOCATION
COUNTY1
ZIP
91773
91786
91750
91773

DRIVE
TIME1,2
*
0.75
*
0.5

A key can be provided see example key, any exceptions must be annotated
Drive time should be reported in hours or fraction of hours from starting location to call, if service provided at a veterinary clinic (place of employment) put 0
*,# see key for times

2

COUNTY
Los Angeles
San Bernardino

ZIP
DRIVE TIME* (h)
91773 <.25
91750
0.25
91784
0.5
91786
0.6

* based on normal route i.e. usually go from farm A to Farm B to Farm C or clinic to farm

DATE

DESCRIPTION
Performed histologic examination of submissions from cattle, goats, and
EX 3/1/2010 pigs and write up pathology reports

TIME (h)

EX 3/1/2010 Mentored student on survey assessing rabies risk factors in farmed deer
EX 3/1/2010 Attended High throughput test development meeting
EX 3/2/2010 Led VDL monthly section meeting

0.5
1.5
1

3

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Section. Do not return the completed form to this address.
National Institute of Food and Agriculture
US Department of Agriculture
OMB No. 0524-0050
Form Approved For Use Through 12/31/2022