Form FDACS-09178 "Agreement for Sentinel Bird Placement for Avian Influenza Surveillance Program" - Florida

Form FDACS-09178 or the "Agreement For Sentinel Bird Placement For Avian Influenza Surveillance Program" is a form issued by the Florida Department of Agriculture and Consumer Services.

Download a PDF version of the Form FDACS-09178 down below or find it on the Florida Department of Agriculture and Consumer Services Forms website.

ADVERTISEMENT

Download Form FDACS-09178 "Agreement for Sentinel Bird Placement for Avian Influenza Surveillance Program" - Florida

1151 times
Rate
(4.5 / 5) 58 votes
Florida Department of Agriculture and Consumer Services
Contact:
Division of Animal Industry
Florida Department of Agriculture
Bureau of Animal Disease Control
and Consumer Services
Poultry Programs Office
407 S. Calhoun Street
ADAM H. PUTNAM
Tallahassee, Florida 32399-0800
AGREEMENT FOR SENTINEL BIRD PLACEMENT FOR
COMMISSIONER
(850) 410-0900 FAX (850) 410-0957
AVIAN INFLUENZA SURVEILLANCE PROGRAM
FreshFromFlorida.com/AI
585, Florida Statutes
5C-16, Florida Administrative Code
Note: All documents and attachments submitted with this request are subject to public review pursuant to Chapter 119, F.S.
Avian Influenza (AI), which is a viral disease that affects many avian species, may become
established in birds on a premises and be a source of future infection. Symptoms may range
from subclinical and very slight to very severe with high mortality. Blood testing and
swabbing of AI negative birds that have then been left on the premises for at least 30 days can
reveal the presence of the virus.
Therefore, to help determine the presence of AI on your premises, ______ sentinel birds which
have been banded and tested negative for AI and originate from a flock that appears to be free
of contagious or infectious disease are being left on your premises for up to 30 days and then
tested for AI. Please have your sentinel birds caught, and confined and ready for testing as
scheduled by the inspector. As soon as you receive notice that the sentinel birds tested
negative the birds become your property and you may keep the birds for future surveillance
testing or dispose of them at your pleasure. Thank you for your cooperation in monitoring
your birds for this disease.
OWNER:
COUNTY:
ADDRESS:
CITY:
ZIP CODE:
PHONE:
(
)
GPS:
Longitude
Latitude
LEG BAND NUMBERS:
DATE PLACED:
EXPECTED TEST DATE:
OWNER’S SIGNATURE:
_______________________________________________
AUTHORIZED TESTING AGENT:
FDACS-09178 Rev. 12/17
Florida Department of Agriculture and Consumer Services
Contact:
Division of Animal Industry
Florida Department of Agriculture
Bureau of Animal Disease Control
and Consumer Services
Poultry Programs Office
407 S. Calhoun Street
ADAM H. PUTNAM
Tallahassee, Florida 32399-0800
AGREEMENT FOR SENTINEL BIRD PLACEMENT FOR
COMMISSIONER
(850) 410-0900 FAX (850) 410-0957
AVIAN INFLUENZA SURVEILLANCE PROGRAM
FreshFromFlorida.com/AI
585, Florida Statutes
5C-16, Florida Administrative Code
Note: All documents and attachments submitted with this request are subject to public review pursuant to Chapter 119, F.S.
Avian Influenza (AI), which is a viral disease that affects many avian species, may become
established in birds on a premises and be a source of future infection. Symptoms may range
from subclinical and very slight to very severe with high mortality. Blood testing and
swabbing of AI negative birds that have then been left on the premises for at least 30 days can
reveal the presence of the virus.
Therefore, to help determine the presence of AI on your premises, ______ sentinel birds which
have been banded and tested negative for AI and originate from a flock that appears to be free
of contagious or infectious disease are being left on your premises for up to 30 days and then
tested for AI. Please have your sentinel birds caught, and confined and ready for testing as
scheduled by the inspector. As soon as you receive notice that the sentinel birds tested
negative the birds become your property and you may keep the birds for future surveillance
testing or dispose of them at your pleasure. Thank you for your cooperation in monitoring
your birds for this disease.
OWNER:
COUNTY:
ADDRESS:
CITY:
ZIP CODE:
PHONE:
(
)
GPS:
Longitude
Latitude
LEG BAND NUMBERS:
DATE PLACED:
EXPECTED TEST DATE:
OWNER’S SIGNATURE:
_______________________________________________
AUTHORIZED TESTING AGENT:
FDACS-09178 Rev. 12/17
ADVERTISEMENT