State, Local, Tribal Gov't

HPAI: Testing, Surveillance, and Reporting of HPAI in Livestock; Dairy Herd Certification

Dairy Cattle Emerging Health Event Epi Questionnaire

State, Local, Tribal Gov't

OMB: 0579-0494

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DAIRY CATTLE EMERGING HEALTH
EVENT: EPIDEMIOLOGICAL
QUESTIONNAIRE

OMB Approved
0579-XXXX
Exp. XX/XXXX

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
2150 CENTRE AVE, BLDG B
FORT COLLINS, CO 80526

Your participation is vital and will help APHIS understand the occurrence and extent of HPAI detections in
cattle. APHIS will safeguard study data as Confidential Business Information (CBI), as defined in the U.S.
Code of Federal Regulations (CFR) 19 CFR 201.6, and we will utilize exemption 4 for any Freedom of
Information Act (FOIA) (5 U.S. Code 552) requests for survey information associated with this study.
Response is voluntary and you may discontinue participation at any time.

Instructions
We are asking you to fill out this survey to provide information on daily farm activities, facility and
premises practices, deliveries to the premises, and sick cattle. The purpose of this survey is to better
understand the emerging health syndrome in dairy cattle first announced by USDA, March 25, 2024, and
to explore potential risk factors for infections in cattle. Any reports from this study will combine the data
from all participants. The results of this survey will be summarized to develop hypotheses and to identify
specific topics for future follow-up studies.
To support rapid data extraction and analysis, please use and save the fillable form electronically when
possible. The form can be downloaded and used on any device with Adobe Acrobat.
In the questionnaire, we frequently ask questions about a 30-day reference period. Questions regarding
the “30-day reference period” refer to the 30 days prior to the date that clinical signs were first
observed on the premises. You might find it helpful to have a calendar and your records handy.

a. Today’s date (mm/dd/yyyy): __________________

date1

b. Date first clinical signs observed (mm/dd/yyyy):___________________

date2

c. Date 30-days before first clinical signs observed (mm/dd/yyyy): ___________________

date3

All questions that ask about the “30-day reference period” refer to the dates between b. and c.
above.

April 12, 2024

Interviewer Notes - General Comments

1

April 12, 2024

Interviewer Notes - General Comments

2

Section A – Premises Information
National Premises Identification Number:
Name of premises:

premid
premname

Address of premises:
Street:

premstreet

City:

premcity

Zip Code:

premzip

County of premises:

-State: _______
_premstate

premcnty

Corporate affiliation/cooperative membership:

premcorp

Premises owner contact name:

ownname

Primary phone:

ownph

Email:

Premises manager name:
Primary phone:

mgrname
mgrph Email:

Premises veterinarian name:
Primary phone:
Interviewee contact name:

veteml

weename
weeph Email:

Interviewer contact name:
Primary phone:

mgreml

vetname
vetph Email:

Primary phone:

owneml

weeeml

wername
werph

Email:

werem

Click "File Name Generator" and Copy the field below it, then click "Save As" button, and paste as file name.

File Name Generator

Save As
April 12, 2024

Interviewer Notes - General Comments & Information Page

3

Section B – Case Information
1. For all cattle that have ever exhibited clinical signs of this syndrome, what clinical sign(s) were
observed? [Check all that apply.] d0001
Lactation related clinical signs:

Respiratory related clinical signs:

a Decreased milk production

i Increased respiratory rate

b Abnormal milk (e.g., consistency, color)

j Labored breathing

c Dry off early

k Nasal discharge
l Blood from nose
m Pneumonia

Digestive related clinical signs:

Other clinical signs:

d Decreased feed consumption

n Neurological signs

e Decreased rumen motility

o Blisters or ulcers

f Diarrhea/Loose manure

p Abortions

g Tacky, dry manure

q Lameness

h Constipation

r Fever (103 °F or greater)
s Dehydration
t Other (specify:

d0001oth)

2. For lactating cows with this syndrome that have produced abnormal milk, were any of the following
characteristics observed? [Check all that apply.] d0002

a Yellow discoloration

e Thickened

b Grey discoloration

f Flakes

c Clear

g Clots

d Apparent blood in milk

h Other (specify:

d0002oth)

3. On average, for cattle on this premises that have shown clinical signs of this syndrome:
a. How many days did they show clinical signs (excluding milk drop)?........... d0003

# days

b

# days

How many days did they experience milk drop? ......................................... d0004

4. When was the first time a veterinarian collected samples from cattle on this premises to diagnose the
cause of clinical signs due to this syndrome? .........................................

April 12, 2024

d0005

Interviewer Notes - General Comments & Questions B.1.- 4.

mm/dd/yy

4

5. Please complete the following table for the class and number of cattle on this operation today.
“Recovered” is defined as returning to the milking string even if there is not a full return to the
previous level of milk production; or, if non-lactating, are no longer receiving supportive care or
appear healthy. (Enter number of animals in whole numbers)

Cattle class

How many
animals of
this class
are on the
premises?
(If 0, go to
next class;
if >0,
continue
this class)

a. Preweaned
dairy or beef
calves

d0006

b. Weaned but
not bred
dairy heifers
c.

d0007

Bred dairy
heifers
d0008

d. 1st lactation
dairy cows
d0009

e. 2nd lactation
dairy cows
d0010

f.

3rd or greater
lactation
dairy cows

d0011

g. Dry dairy
cows
d0012

h. Beef cows,
bulls, steers,
and heifers
i.

How many
animals of
this class
have been
culled due
to this
syndrome?

How many
animals of
this class
have died
due to this
syndrome?

d0025

d0035

d0045

d0055

d0026

d0036

d0046

d0056

d0027

d0037

d0047

d0057

d0028

d0038

d0048

d0058

d0029

d0039

d0049

d0059

d0030

d0040

d0050

d0060

d0031

d0041

d0051

d0061

d0032

d0042

d0052

d0062

d0033

d0043

d0053

d0063

 1 Yes
 3 No d0016
 1 Yes
 3 No d0017
 1 Yes
 3 No d0018
 1 Yes
 3 No d0019
 1 Yes
 3 No d0020
 1 Yes
 3 No d0021
 1 Yes
 3 No d0022

 1 Yes
 3 No d0024
0

0
d0015

April 12, 2024

How many
animals of
this class
have
recovered
from this
syndrome?

d0013

Dairy bulls

Total (a. – i.)

How many
animals of
this class
have
exhibited
clinical
signs to
date?

 1 Yes
 3 No d0023

d0014

j.

Have any
animals of
this class
exhibited
clinical
signs to
date?
(If No, go to
next class;
if Yes,
continue this
class)

0
d0034

0
d0044

Interviewer Notes - General Comments & Question B.5.

0
d0054

d0064

5

6. During the reference period, were any dairy heifers from this premises being raised off-site with retained
ownership? ................................................................................................................. d0065

 1 Yes 3 No

a. If Yes, which of the following best describes the off-site rearing facility? [Check only one.] d0066
Dairy heifers are sent to:

1 A single rearing facility and do not have any contact with cattle from other operations.
2 Multiple rearing facilities and do not have any contact with cattle from other operations.
3 A single rearing facility and have contact with cattle from other operations.
4 Multiple rearing facilities and have contact with cattle from other operations.
5 Other (specify:

d0066oth)

7. How many pens are on this premises? ............................................................. d0067

# pens

8. Have clinical signs been observed in multiple pens? ............................................. d0068

1 Yes 3 No

[If Yes, continue. If No, go to Section C.]
a. How many pens have animals that have exhibited clinical signs to date? . d0069

# pens

b. For each affected pen, what was the first day clinical signs were observed in the pen, the pen
number, the cattle class of the pen, and the average days in milk for cattle in the pen?
(If more space is needed, please use the continuation table at the end of the questionnaire. If
possible, please attach labeled site map. Enter average days in whole numbers)
Date clinical signs
were first observed in
the pen (mm/dd/yy)

Pen number

Cattle class

Pen average
days in milk

d0070a

d0070b

________________________________________
d0070c

d0070d

d0071a

d0071b

________________________________________
d0071c

d0071d

d0072a

d0072b

________________________________________
d0072c

d0072d

d0073a

d0073b

________________________________________
d0073c

d0073d

d0074a

d0074b

________________________________________
d0074c

d0074d

d0075a

d0075b

________________________________________
d0075c

d0075d

[Go To Continuation Table]
Click to go to Continuation Table
April 12, 2024

Interviewer Notes - General Comments & Questions B.6.- 8.b.

6

c.

Have animals showing clinical signs been observed in: [Check all that apply.] d0076

a Adjacent pens?
b Non-adjacent pens?
c Other (specify:

d0076oth)

d. For pens with lactating cows, has the order that pens have first shown clinical signs followed the
same order that those pens visit the milking parlor?............................ d0077

1 Yes 3 No 4 Don’t Know

e. If Yes, please describe:
d0078oth

Section C – Herd Description
1. During the 30-day reference period, which one of the following practices best describes this dairy
operation? [Check only one.] d0100

1 Conventional (majority of forage consumed is not harvested by cows)
2 Grazing (majority of forage consumed is harvested by cows during the growing season)
3 Combination of conventional and grazing
4 Other (specify:

d0100oth)

2. Of the dairy cows on this operation today, approximately what percent are:
a. Holstein?. ................................................................................................................. d0101

%

b. Jersey? .................................................................................................................... d0102

%

c.

%

Other, including mixed dairy breeds? (specify:

d0103oth) d0103

Total (should equal 100%) 0

%

3. Is this premises producing raw milk or raw/unpasteurized milk cheese products for human
consumption or for a cow share program? ............................................................. d0104

1 Yes 3 No

4. Is this premises certified organic? .......................................................................... d0105

1 Yes 3 No

5. During the 30-day reference period, what was the primary housing type used for each of the
following types of cattle while on this operation?
[Insert the appropriate housing type code from the table below.]
Housing type codes
1

Individual outside hutch/pen

5

Freestall with or without access to open/dry lot

2

Individual inside hutch/pen – heated or
nonheated calf barn

6

Open/dry lot/multiple animals outside area with
or without barn or shed (excludes pasture)

3

Tie stall or stanchion

7

Multiple animals inside area/barn

4

Pasture

8

Other (specify in Other column according to
cattle type)

April 12, 2024

Interviewer Notes - General Comments & Questions B.8.c.- C.5.

7

Other (specify)

a. Preweaned dairy heifers. .............................................. d0107/d0107oth

______________

b. Weaned, but not bred, dairy heifers. .............................d0108/d0108oth

_ _____________

c.

Bred dairy heifers .......................................................... d0109/d0109oth

______________

d. Lactating cows. .............................................................d0110/d0110oth

_ _____________

e. Dry cows. ......................................................................d0111/d0111oth

_ _____________

6. During the 30-day reference period, were the following animal types present on this operation?
If Yes, have any of these animal types been sick or died? Were any of the following animal types
present on an adjacent operation(s) where fence-line contact with this operation’s cattle was
possible?
On this operation?
(If Yes, answer Sick
column; if No, go to Have any animals of
Adjacent Operation this type been sick
column)
or died?

Animal type

 1 Yes  3 No
 4 Don’t know d0132

a. Dairy cattle

b. Beef cattle

 1 Yes 3 No

 1 Yes  3 No

d0112

d0122

c.

 1 Yes 3 No

 1 Yes  3 No

d0113

d0123

d. Horses, donkeys,
mules, or similar

 1 Yes 3 No

 1 Yes  3 No

d0114

d0124

e. Pigs (domestic)

 1 Yes 3 No

 1 Yes  3 No

d0115

d0125

f.

 1 Yes 3 No

 1 Yes  3 No

d0116

d0126

g. Sheep

 1 Yes  3 No

 1 Yes 3 No

d0117

d0127

h. Goats

 1 Yes 3 No

 1 Yes  3 No

d0118

d0128

i.

Dogs (domestic or feral)

 1 Yes 3 No

 1 Yes  3 No

d0119

d0129

j.

Cats (domestic or feral)

 1 Yes 3 No

 1 Yes  3 No

d0120

d0130

k.

Other
(specify:

 1 Yes 3 No

 1 Yes  3 No

d0121

d0131

Chickens or other
poultry

Pigs (feral)

)
d0121oth

April 12, 2024

On an adjacent
operation where fenceline contact with this
operation’s cattle was
possible?

Interviewer Notes - General Comments & Questions C.5.- 6.

 1 Yes  3 No
 4 Don’t know d0133
 1 Yes  3 No
 4 Don’t know d0134
 1 Yes  3 No
 4 Don’t know d0135
 1 Yes  3 No
 4 Don’t know d0136
 1 Yes  3 No
 4 Don’t know d0137
 1 Yes  3 No
 4 Don’t know d0138
 1 Yes  3 No
 4 Don’t know d0139
 1 Yes  3 No
 4 Don’t know d0140
 1 Yes  3 No
 4 Don’t know d0141
 1 Yes  3 No
 4 Don’t know d0142
8

7. Are there any commercial poultry operations located within 5 miles of this operation’s cattle herd?

1 Yes 3 No 4 Don’t Know

.................................................................................................... d0143

8. During the 30-day reference period, where were this operation’s dead cattle disposed?
[Check only one.] d0144

1 On-site
2 Off-site
3 Both
4 Not applicable – no deaths
Section D – Milking Procedures
1. What type of milking facilities are used on this operation? [Check all that apply.] d0201

a Parlor
b Tie stall or stanchion barn
c Robotic/voluntary milking systems
d Other (specify:

d0201oth)

2. During the 30-day reference period, how many times per day were the majority of cows milked?
[Check only one.] d0202

1 Once a day
2 Twice a day
3 Three times a day
4 More than three times a day
3. Are all cows milked the same number of times per day? ...................................... d0203

1 Yes 3 No

a. If No, does the frequency of milking seem to be associated with clinical signs? (i.e., has there
been a difference in the number of cows with clinical signs based on the number of times they were
milked per day?) ........................................................................ d0204

1 Yes 3 No 4 Don’t know

(1). If Yes to Question 3.a., please explain:

d0205oth

4. During the 30-day reference period, were the teats sprayed with water or another solution, excluding
pre-teat dip, prior to milking? .................................................................................. d0206

 1 Yes  3 No

5. During the 30-day reference period, was forestripping performed prior to milking?
. ....................................................................................................................... d0207
6.

During the 30-day reference period, were teats pre-dipped prior to milking? ...... d0208

 1 Yes  3 No
1

Yes

3

No

[If Yes, continue. If No, go to Question 7.]
April 12, 2024

Interviewer Notes - General Comments & Questions C.7.-D.6.a.

9



a. Please specify product used:

April 12, 2024

Interviewer Notes - General Comments & Questions C.7.-D.6.a.



d0209oth

10

b. What method was used to apply pre-dip? [Check only one.] d0210

1 Teat dipping cup
2 Teat sprayer
3 Automatic brush with scrubber and dryer
4 Other (specify:

d0210oth)

7. During the 30-day reference period, how were the teats dried prior to milking? [Check all that apply.]
d0211

a Paper towel used on one cow only
b Paper towel used on more than one cow
c Cloth towel used on one cow only
d Cloth towel used on more than one cow
e Not applicable – teats were not dried
8. During the 30-day reference period, were teats post-dipped after milking?........ d0212

1 Yes 3 No

a. If Yes, please specify product used:

d0213oth

9. During the 30-day reference period, did this operation use a backflush system in milking units?
................................................................................................................................ d0214

 1 Yes  3 No

a. If Yes, was the backflush system:
(1). Used for every milking? ............................................................................. d0215

 1 Yes  3 No

1 Automatic 2 Manual

(2). Automatic or manual?.............................................................. d0216

(3). Does the backflush system include a disinfectant?................................... d0217

1 Yes 3 No

10. During the 30-day reference period, did parlor workers wear disposable gloves while milking cows?
........................................................................................... d0218


1 Always


2Sometimes

3Never

a. If Always or Sometimes, on average how many cows were contacted while wearing a single pair of
gloves? [Check only one.] d0219

1 Only 1 2 2–10 3 11–50 4 51–100 5 101+

[If this operation has a parlor, continue. If not, go to Question 13.]
11. During the 30-day reference period, was the parlor cleaned after each milking shift?
........................................................................................... d0220


1Always

2Sometimes 3Never

a. If Always or Sometimes, which of the following best describes the cleaning procedures? [Check
only one.] d0221

1 Wash parlor with water or steam only
2 Chemically disinfect only
3 Wash with water and chemically disinfect
4 Other (specify:
April 12, 2024

d0221oth)

Interviewer Notes - General Comments & Questions D.6.b.-11.

11

12. Does this operation use a CIP (clean in place) system? ..................................... d0222

1 Yes 3 No

a. If Yes, how many times a day is cleaning conducted? [Check only one.] d0223

1 1
2 2
3 3
4 4 or more
13. Have any of the milking or parlor practices changed since the syndrome was first observed on this
premises?

.......................................................................................................... d0224

a. If Yes, please explain:

1 Yes 3 No
d0225oth

14. During the 30-day reference period, did milk trucks pick up partial semi-truck loads from this dairy?
...................................................................................................... d0226  1 Yes

3 No 4 Don’t Know

15. During the 30-day reference period, approximately how much waste milk was produced daily on this
premises?

.............................................................................................

d0227

(gallons/day)

16. During the 30-day reference period, which of the following practices were used to dispose of waste
milk on this premises? For each practice used, was the waste milk pasteurized/heat treated, chemical
treated, or not treated prior to the disposal practice?
Practice to dispose of waste milk:
(If checked, answer Treatment column)
[Check all that apply.] d0228

Treatment prior to the disposal practice?
[Check all that apply.]

 a Fed to calves on this dairy

 a Pasteurized/ heat treated
 b Chemical treatment  c No treatment

d0229

 b Fed to calves at another premises

 a Pasteurized/ heat treated
 b Chemical treatment  c No treatment

d0230

 c Fed to swine (on or off-site)

 a Pasteurized/ heat treated
 b Chemical treatment  c No treatment

d0231

 d Fed to cats/dogs on the dairy

 a Pasteurized/ heat treated
 b Chemical treatment  c No treatment

d0232

 e Disposed in lagoon

 a Pasteurized/ heat treated
 b Chemical treatment  c No treatment

d0233

 a Pasteurized/heat treated
 b Chemical treatment  c No treatment

d0234

 f Other (specify:

)
d0228oth

17. Have the waste milk disposal and/or waste milk treatment practices changed since the syndrome was
first observed on this premises? ......................................................................... d0235
April 12, 2024

Interviewer Notes - General Comments & Questions D.12.-17.

1 Yes 3 No
12

a. If Yes, how have practices changed:

d0236oth

Section E – Animal Movements
1. Were animals of the following cattle classes added to this premises during the 30-day reference
period?
Added to the premises
during the 30-day
reference period?

Cattle class
a. Preweaned dairy or beef calves

 1 Yes 3 No

b. Weaned but not bred dairy heifers

 1 Yes 3 No

c. Bred dairy heifers

 1 Yes 3 No

d. Fresh dairy heifers

 1 Yes 3 No

e. Lactating dairy cows

 1 Yes 3 No

d0301

d0302

d0303

d0304

d0305

f. Dry dairy cows

 1 Yes 3 No

g. Beef cows, bulls, steers, heifers

 1 Yes 3 No

h. Dairy bulls

 1 Yes 3 No

d0306

d0307

d0308

2. Please describe all movements of cattle onto this premises beginning with the start of the 30-day
reference period.
(Answer all columns for each movement. If more space is needed, please use the continuation table
at the end of the questionnaire.)
Date of movement
(mm/dd/yy)

Cattle class/type

Number of
head

Origin
(premises/farm name, city, state)

d0309a

__________________________
d0309b

d0309c

d0309d

d0310a

__________________________
d0310b

d0310c

d0310d

April 12, 2024

Interviewer Notes - General Comments & Questions D.17.a.- E.2.

13

d0311a

__________________________
d0311b

d0311c

d0311d

d0312a

__________________________
d0312b

d0312c

d0312d

d0313a

__________________________
d0313b

d0313c

d0313d

[Go To Continuation Table]
Click to go to Continuation Table
3. Were animals of the following cattle classes removed from the premises during the 30-day
reference period or since clinical signs were first observed? [Answer both columns.]
Removed from the
premises during the 30day reference period?

Cattle class

Removed from the
premises since clinical
signs were first
observed?

a. Preweaned dairy or beef calves

 1 Yes 3 No

 1 Yes  3 No

d0314

d0322

b. Weaned but not bred dairy heifers

 1 Yes 3 No

 1 Yes  3 No

d0315

d0323

c. Bred dairy heifers

 1 Yes 3 No

 1 Yes  3 No

d0316

d0324

d. Fresh dairy heifers

 1 Yes 3 No

 1 Yes  3 No

d0317

d0325

e. Lactating dairy cows

 1 Yes 3 No

 1 Yes  3 No

d0318

d0326

f. Dry dairy cows

 1 Yes 3 No

 1 Yes  3 No

d0319

d0327

g. Beef cows, bulls, steers, heifers

 1 Yes 3 No

 1 Yes  3 No

d0320

d0328

h. Dairy bulls

 1 Yes 3 No

 1 Yes  3 No

d0321

d0329

4. Please describe all movements of cattle off this premises beginning with the start of the 30-day
reference period.
(Answer all columns for each movement. If more space is needed, please use the continuation table
at the end of the questionnaire.)

April 12, 2024

Interviewer Notes - General Comments & Questions E.2.- 4.

14

Date of movement
(mm/dd/yy)

Cattle class/type

Number of
head

Destination
(premises/farm name, city, state)

d0330a

__________________________
d0330b

d0330c

d0330d

d0331a

__________________________
d0331b

d0331c

d0331d

d0332a

__________________________
d0332b

d0332c

d0332d

d0333a

__________________________
d0333b

d0333c

d0333d

d0334a

__________________________
d0334b

d0334c

d0334d

[Go To Continuation Table]
Click to go to Continuation Table
5. During the 30-day reference period, how often were the following types of cattle isolated (kept
physically separated) before being comingled with this operation’s cattle?
(Check NA if not applicable, i.e., did not have cattle return and/or join during the time frame.)
a. Cattle returning to the operation? .................... d0335 1 Always

2 Sometimes 3 Never 4 NA

b. New cattle joining the operation (permanently or temporarily)?
............................................................................. d0336  1 Always

2 Sometimes 3 Never 4 NA

[If Questions 5. a. and b. BOTH are Never or NA, go to Question 7.]
6. How many days were these types of cattle typically isolated?
(Check NA if not applicable, i.e., did not have cattle return and/or join during the time frame.)
a. Cattle returning to the operation? ................................................

d0337

# days

4 NA

# days

4 NA

b. New cattle joining the operation (permanently or temporarily)?
....................................................................................................d0338

7. During the 30-day reference period, did any cattle leave this operation for any purpose (e.g.,
veterinary clinic, show, sale, petting zoo, or similar) and then return to this operation?
................................................................................................................................ d0339


1 Yes

3 No

Section F – Operation Management
April 12, 2024

Interviewer Notes - General Comments & Questions E.4.- 7.

13

1. During the 30-day reference period, which of the following describes your standard colostrum
feeding practices for calves? [Check only one.] d0401

1 Unpasteurized cow colostrum from a single dam
2 Pasteurized cow colostrum from a single dam
3 Unpasteurized pooled cow colostrum
4 Pasteurized pooled cow colostrum
5 Commercial colostrum replacer
6 Calves are not fed colostrum
2. Which of the following liquid diets are calves fed prior to weaning? [Check all that apply.] d0402

a Medicated/Nonmedicated milk replacer
b Unpasteurized milk
c Pasteurized milk
d Acidified milk
e Other (specify:

d0402oth)

3. What are the water sources for cattle?
a. Off-site fresh water (e.g., municipal, community, commercial) ..................... d0403

1 Yes 3 No

b. Well ............................................................................................................... d0404

1 Yes 3 No

c.

1 Yes 3 No

Surface water (e.g., pond, canal)................................................................... d0405

d. Other (specify:

d0406oth)

............... d0406

1 Yes 3 No

4. Are water treatments (e.g., chlorination) used in the drinking water for the cattle on this operation?
....................................................................................................................... d0407
a. If Yes, are these treatments conducted: ...................... d0408

1 Yes 3 No

1 Continuously? 3 Intermittently?

5. During the 30-day reference period, which best describes how frequently the water delivery
systems (e.g., water tank or trough, waterer) were drained and cleaned? [Check only one.] d0409

1 Daily 2 Weekly 3 2-3 times per month 4 Never
For the next two questions, “Always” is 100% of the time, “Most of the time” is 51–99% of the time,
“Sometimes” is 1–50% of the time, and “Never” is 0% of the time.
6. During the 30-day reference period, how often were wild birds observed in/around sources from
which the cows drink? [Check only one.] d0410

1 Always 2 Most of the time 3 Sometimes 4 Never
7. Where are feed rations fed at this dairy being mixed? [Check only one.]
........................................................................ d0411 1 At this dairy

2 At a location off-site 3 Both

8. Do feed components include:
April 12, 2024

Interviewer Notes - General Comments & Questions F.1.- 8.a.

14

a. Feather/other poultry meal ....................................................... d0412

April 12, 2024

1



Yes

3

Interviewer Notes - General Comments & Questions F.1.- 8.a.

No

4

Don’t Know

14

b. Poultry litter/manure .................................................................. d0413  1 Yes

 3 No  4 Don’t Know

c. Other poultry byproducts ........................................................... d0414  1 Yes

 3 No  4 Don’t Know

(1). If Yes, specify:

d0415oth

9. During the 30-day reference period, how frequently were wild birds, wild animals, and rodents able
to access cattle feed or feed ingredients (e.g., feed spillage, open bag, cover left open, feedline,
commodity bays)? For the next two questions, “Always” is 100% of the time, “Most of the time”
is 51–99% of the time, “Sometimes” is 1–50% of the time, and “Never” is 0% of the time.
Always

Most of the
time

Sometimes

Never

a. Large birds (e.g., waterfowl such
as ducks and geese, raptors such
as hawks) d0416

1

2

3

4

b. Small birds (e.g., finches,
sparrows, starlings, pigeons,
blackbirds, grackles, cowbirds)

1

2

3

4

Wild animals (e.g., raccoons,
opossums, coyotes, feral swine,
deer, rabbits, foxes) d0418

1

2

3

4

d. Rodents (e.g., rats, mice, squirrels,
gophers) d0419

1

2

3

4

Animal type

d0417

c.

10. During the 30-day reference period, did this operation ever transport cattle in trucks and/or trailers
shared with other livestock operations? ................................................................ d0420 1 Yes

3 No

[If No, go to Question 13.]
11. Were shared trucks or trailers cleaned prior to use? ............................................. d0421

1 Yes 3 No

12. Which of the following best describes the cleaning procedures? [Check only one.] d0422

1 Wash vehicle with water or steam only
2 Chemically disinfect only
3 Wash vehicle and chemically disinfect
4 Other (specify:

d0422oth)

13. During the 30-day reference period, did this operation ever use the same equipment to handle
manure and feed? .................................................................................................. d0423 1 Yes

3 No

[If No, go to Question 17.]
14. Were separate buckets used to handle manure and feed? .................................. d0424

1 Yes 3 No

15. Was equipment (excluding separate buckets) cleaned between use for manure and use for feed?
April 12, 2024

Interviewer Notes - General Comments & Questions F.8.b.- 15.

15

................................................................................................................................ d0425

April 12, 2024

Interviewer Notes - General Comments & Questions F.8.b.- 15.

Yes

1


3


No

15

16. If Yes to Question 15, which of the following best describes the cleaning procedures? [Check only one.] d0426

1 Wash equipment with water or steam only
2 Chemically disinfect only
3 Wash equipment and chemically disinfect
4 Other (specify:

d0426oth)

17. What kind(s) of bedding are used on this dairy? [Check all that apply.] d0427

 a Wood shavings and/or sawdust
b Straw and/or hay
c Sand
d Rice hulls
e Paper
f Compost and/or dried manure
g Rubber mats/mattress
h Other (specify:

d0427oth)

18. Prior to use, is fresh bedding accessible to:
a. Wild birds ....................................................................................................... d0428

1 Yes 3 No

b. Wild animals (e.g., raccoons, opossum, coyotes, foxes)............................... d0429

1 Yes 3 No

c.

1 Yes 3 No

Domestic animals (e.g., dogs, cats)............................................................... d0430

19. What type of water is used to flush the alleys? [Check all that apply.] d0431

 a Lagoon or recycled flush water
b Surface pond water
c Municipal water
d Well water
e None
f Other (specify:

d0431oth)

20. During the 30-day reference period or since clinical signs were first observed, was manure on
this operation: [Answer both columns.]
30-day reference period
a. Stored on premises?
b. Composted for bedding?
April 12, 2024

Since clinical signs were
first observed

 1 Yes  3 No

 1 Yes 3 No

d0432

d0436

 1 Yes  3 No

 1 Yes 3 No

d0433

d0437

Interviewer Notes - General Comments & Questions F.16.- 20.b.

16

c. Applied to land managed by this
premises?

 1 Yes  3 No

 1 Yes 3 No

d0434

d0438

d. Removed, sold, or given away?

 1 Yes  3 No

 1 Yes 3 No

d0435

d0439

21. During the 30-day reference period, was manure or used bedding from other premises brought onto
this operation? .............................................................................. d0440  1 Yes

3 No 4 Don’t Know

Questions 22–26 refer to persons such as the producer, employees, farm help, crews, or similar.
22. What is the total number of employees working on this operation that have access to or directly work
with the cattle (including family, both paid and unpaid)? ....................................... d0441

#

23. During the 30-day reference period, did any workers on this operation visit another dairy premises?
...................................................................................................... d0442 1 Yes

3 No 4 Don’t know

24. During the 30-day reference period, did any workers on this operation visit livestock shows or 4-H
events? ......................................................................................... d0443  1 Yes

3 No 4 Don’t know

25. Are any workers or members of their households employed by any of the following:

a. Workers

b. Members of
household

Other dairy
operations?

Swine farms?

Poultry farms?

Other livestock
operations?

 1 Yes 3 No
 4 Don’t know

 1 Yes 3 No
 4 Don’t know

 1 Yes 3 No
 4 Don’t know

 1 Yes 3 No
 4 Don’t know

d0444

d0446

d0448

d0450

 1 Yes 3 No
 4 Don’t know

 1 Yes 3 No
 4 Don’t know

 1 Yes 3 No
 4 Don’t know

 1 Yes 3 No
 4 Don’t know

d0445

d0447

d0449

d0451

26. Do any employees own their own livestock and/or poultry, including small backyard herds/flocks?
...................................................................................................... d0452  1 Yes

3 No 4 Don’t know

27. During the 30-day reference period, did any of the following types of people visit this operation?
If Yes, how many times did they visit and did they have physical contact with the cattle?
Did they visit the
operation?
(If Yes, answer next
two columns)

Visitor type
a. Veterinarian

 1 Yes 3 No

b. Nutritionist or feed consultant

 1 Yes 3 No

c.

 1 Yes  3 No

Breeding technician

April 12, 2024

d0453

d0454

d0455

If Yes,
How many times
did they visit?

Did this visitor have
physical contact
with cattle?

 1 Yes  3 No
d0453a

d0453b

 1 Yes  3 No
d0454a

d0454b

 1 Yes  3 No
d0455a

Interviewer Notes - General Comments & Questions F.20.c.-27.c.

d0455b

17

d. Feed or feed ingredient
delivery personnel

 1 Yes 3 No

e. Milk hauler

 1 Yes 3 No

f.

 1 Yes  3 No

d0456

d0457

Contract hauler driver or
vehicle (e.g., cattle, manure)

d0458

d0456b

 1 Yes  3 No
d0457a

d0457b

 1 Yes  3 No
d0458a

d0458b

 1 Yes 3 No

g. Renderer

d0459

h.

Hoof trimmer

i.

Other
(specify:

 1 Yes  3 No
d0459a

d0459b

 1 Yes 3 No
d0460

)

 1 Yes  3 No

)

 1 Yes  3 No

d0461oth

j.

 1 Yes  3 No
d0456a

Other
(specify:
d0462oth

d0461

d0462

 1 Yes  3 No
d0460a

d0460b

 1 Yes  3 No
d0461a

d0461b

 1 Yes  3 No
d0462a

d0462b

28. During the 30-day reference period, was a washroom with running water and soap available in the
milking barn? ...................................................................... d0463 1 Always

2 Sometimes 3 Never

Section G – Environmental Factors & Wild Birds
1. Are the following water body types visible or within 350 yards (about three football fields) of this
operation?
a. Pond or lake ..................................................................................................... d0501

1 Yes 3 No

b. Stream or river ................................................................................................. d0502

1 Yes 3 No

c.

Wetland or swamp ........................................................................................... d0503

1 Yes 3 No

d. Wastewater lagoon .......................................................................................... d0504

1 Yes 3 No

e. Standing water during the 30-day reference period ...................................... d0505

1 Yes 3 No

f.

1 Yes 3 No

Water ditch or canal ......................................................................................... d0506

g. Other (specify:

d0507oth)

.......... d0507

1 Yes 3 No

[If Question 1.a. through g. are all No, go to Question 3.]
2. For those water bodies, including drainage ditches and lagoons within 350 yards of the operation,
approximately how many wild waterfowl or shorebirds (e.g., ducks, geese, wading birds, gulls) were
seen on the water during the 30-day reference period? [Check only one.] d0508

1 None 2 Tens 3 Hundreds 4 Thousands 5 Don’t know
3. What is the approximate distance (in yards) to the closest field where crops or hay are harvested?
[Check only one.] d0509

1 50 yards or less 2 51–100 yards 3 101–350 yards 4 351 yards or more
April 12, 2024

Interviewer Notes - General Comments & Questions F.20.d.- G.3.

18

4. For this closest field, approximately how many wild waterfowl or shorebirds (e.g., ducks, geese,
wading birds, gulls) were seen during the 30-day reference period? [Check only one.] d0510

1 None 2 Tens 3 Hundreds 4 Thousands 5 Don’t know
5. During the 30-day reference period, how frequently were the following types of wild birds seen on
the operation and within 100 yards of the cattle?
For this question, “Often” is 51–100% of the time, “Sometimes” is 1–50% of the time, and “Never” is
0% of the time.
Often

Sometimes

Never

1

2

3

b. Gulls d0512

1

2

3

c.

1

2

3

d. Pigeons and doves d0514

1

2

3

e. Blackbirds, crows, cowbirds,
grackles d0515

1

2

3

f.

Small perching birds (e.g.,
sparrows, starlings, swallows) d0516

1

2

3

g. Wild turkeys, pheasants, quail d0517

1

2

3

h. Raptors (e.g., eagles, hawks, owls,
vultures) d0518

1

2

3

1

2

3

Bird type
a. Waterfowl (e.g., ducks, geese)
d0511

i.

Other water birds (e.g., egrets,
cormorants) d0513

Other d0519
(specify:

)
d0519oth

6. During the 30-day reference period, did you or other farm workers observe any sick or dead wild
birds on the premises? ........................................................................................ d0520 1 Yes

3 No

[If No, go to Question 7.]
a. Specify the type(s) of sick or dead birds:

d0521oth

b. Were any sick or dead birds tested for HPAI? ......................... d0522

1 Yes 3 No 4 Don’t Know

(1) If Yes to Question 6.b., were any positive?......................... d0523

1 Yes 3 No 4 Don’t Know

7. During the 30-day reference period, how often were the following wild animals, or evidence of their
presence, seen on the premises?

April 12, 2024

Interviewer Notes - General Comments & Questions G.4.- 7.

19

For this question, “Often” is 51–100% of the time, “Sometimes” is 1–50% of the time, and “Never” is
0% of the time.
a. Wild mammals (e.g., raccoons, opossum, coyotes, foxes)
..................................................................................... d0524 1 Always
b. Rodents (e.g., rats, mice, squirrels, gophers).............. d0525

2 Sometimes 3 Never

1 Always 2 Sometimes 3 Never

8. Does this premises have a written wildlife management plan that includes methods to minimize
wildlife or wild bird entry and reduce wildlife attractants such as standing water?
.............................................................................................................................. d0526


1 Yes

3 No

Comments Section
Please use this section for anything else you would like to add. For example, how do you think HPAI
was/is spreading on your operation or in the geographic area? Is there something about your operation or
your experience with this syndrome that you would like to share? d0601

Please attach any additional information you think would be valuable to this investigation, such as
laboratory results prior to syndrome diagnosis, a site map with impacted pens labeled, full ration
ingredient list, milk production records, hospital records, or the number of cows impacted per day.
April 12, 2024

Interviewer Notes - General Comments & Questions G.7.- 8.

20

Section B, Question 8.b. Continuation Table
Date clinical signs
were first observed in
the pen (mm/dd/yy)

Pen number

Pen average
days in milk

Cattle class

d0080a

d0080b

_______________________________________
d0080c

d0080d

d0081a

d0081b

_______________________________________
d0081c

d0081d

d0082a

d0082b

_______________________________________
d0082c

d0082d

d0083a

d0083b

_______________________________________
d0083c

d0083d

d0084a

d0084b

_______________________________________
d0084c

d0084d

[Return
8.c.]
ClicktotoSection
returnB,
toQuestion
Section B
Section E, Question 2. Continuation Table
Date of movement
(mm/dd/yy)

Cattle class/type

Number of
head

Origin
(premises/farm name, city, state)

d0350a

__________________________
d0350b

d0350c

d0350d

d0351a

__________________________
d0351b

d0351c

d0351d

d0352a

__________________________
d0352b

d0352c

d0352d

d0353a

__________________________
d0353b

d0353c

d0353d

d0354a

__________________________
d0354b

d0354c

d0354d

April 12, 2024

Interviewer Notes - General Comments & Questions B.8.b & E.2.

21

d0355a

__________________________
d0355b

d0355c

d0355d

[Return
ClicktotoSection
return E,
to Question
Section E3.]
Section E, Question 4. Continuation Table
Date of movement
(mm/dd/yy)

Cattle class/type

Number of
head

Destination
(premises/farm name, city, state)

d0360a

__________________________
d0360b

d0360c

d0360d

d0361a

__________________________
d0361b

d0361c

d0361d

d0362a

__________________________
d0362b

d0362c

d0362d

d0363a

__________________________
d0363b

d0363c

d0363d

d0364a

__________________________
d0364b

d0364c

d0364d

d0365a

__________________________
d0365b

d0365c

d0365d

[Return
to return
SectiontoE,Section
Question
Click to
E 5.]

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Interviewer Notes - General Comments & Questions E.2.& 4.

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