College of Veterinary Medicine

Instructions for Completion of the Commercial Poultry Incident Form

This document will dissect the commercial poultry incident form by section and guide you on how to correctly complete this form.  Having accurate and fully complete forms is essential to ensuring that samples get run on time.  If you have any questions regarding filling out this form, please call us ahead of submission so that we can clarify the process and prevent any slowdowns associated with accessioning of the samples.

Additional Important Information

  • Please, 
    •  Bag and label samples from each premises separately. If there are samples from more than one house or barn, we will need to be able to identify them at the lab. 
      • List the house/barn ID on the bag/tubes
  • Complete one submission form for each premises.
  • Keep all paperwork separate from the samples and prevent cross-contamination.
  • If submitting samples from multiple premises, please mark the Bag# field at the top left of the submission forms a consecutive count of numbers (1,2,3 etc.) and mark the corresponding bag of samples with the same number with a Sharpie.  This will help speed up identifying samples for the labeling process at ADDL.
  • Please scan all submission forms into a .PDF document and email the file to addlhpai@purdue.edu as soon as possible, with details about delivery. This will greatly improve the turnaround time for results if we can have paperwork before the samples arrive at ADDL.
  • Disinfect the outside of tubes, bags, and packages. This will help prevent cross contamination as samples are handled, moved, and received at the laboratory.
  • Contact the ADDL with questions:

Form Fields — Guidance by Section

Company

  • List the company for which the samples are being submitted for.
  • List the veterinarian or contact person that will be responsible for shipping samples and receiving results.
  • List the phone number of the company vet or contact person here. The individual listed here should be readily available in order to clarify any inconsistencies on the form.

Flock Information

  • Site / Farm / Unit: List the name of the site that samples are coming from.
  • Flock # / ID: Label the flocks number if applicable
  • Age: List the age and them mark if the number represents days, weeks, months, or years.
    • If there are multiple barns and different ages, please list the ages down with the barn information in the lower section of the form.
  • Additional information: In this section, list any relevant information you would like to clarify with the lab.  If, for example, this is a mortality/morbidity event, it would be appropriate to note any relevant clinical signs/mortality/differential diagnoses/drops in water consumption, etc.

Tests Requested

  • You will mark either Avian Influenza or Newcastle Disease, depending on the current incident.
  • Additional: this field is for additional testing that is required/requested.  Please list the name of the additional test and if it should be run at the same time or if it is able to be run later.

Premises ID Barcode

  • This is where you will place your federal premises ID barcode.  It starts with two zeros.
  • Please contact the Board of Animal Health (BOAH) if you need assistance with printing barcodes.
  • If barcode stickers are not available, please hand write the federal premises ID here.  Make sure to write legibly so that the number is interpreted properly.

Reason for Submission

  • Here you will mark the reason for submission of the samples associated with the form. Your reason for submission will likely change during the process of an outbreak. Make sure you mark this section carefully. If you have any questions regarding the reason for submission or need clarification for a given shipment of birds or products, please reach out to BOAH.
  • You will only choose one type of reason for each submission. The exception is for permitted movement. For permitted movement, select the box and the type of movement in the subcategory list.
  • Reason Definitions
    • Morbidity / Mortality - when birds are sick or dying.
    • Surveillance-when routine testing is being done (i.e. weekly surveillance testing during the incident).
    • Post C&D - only for previously infected sites to do environmental testing after cleaning and disinfection is completed.
    • Pre-Restocking - for testing of birds before they are moved onto a previously infected premises.
    • Post-Restocking - only for previously infected sites to test birds after new birds have been added back to the premises.
    • Permitted Movement - when testing needs to be completed to allow birds or bird products to be moved to or from a premises within the control area.
    • Traceback / Traceforward - for use when the testing of birds or bird products is needed due to potential exposure of an infected premises, animal, or other risk.

Type

  • Select the most appropriate production type of the premises.

Species

  • Select the species classification of the birds being tested.

Collection Date

  • Enter the date on which samples were collected.

Incident Area / Zone

  • This is where you will note what incident area, zone, and state the flock being sampled ORIGINATES from.
  • Premises state: enter the state where birds located in when the sample collection takes place.
  • Incident ID / FADI #: enter the incident name/code assigned by BOAH. This name is usually a county abbreviation followed by an incident number. Example: E1, D2 etc. If the testing is with a morbidity/mortality event and a Foreign Animal Disease Investigation, please enter that number provided by BOAH oro USDA in this field.
  • The control area and surveillance zones are established and named by BOAH in relation to proximity to an infected premises.

Sample Type

  • Note if the samples are oropharyngeal swabs (including the choanal cleft), cloacal (for waterfowl), or environmental swabs.

Sample Description

Samples Submitted

  • In this section you will note how many tubes are being submitted for each barn/site on the premise for which samples are being submitted.  The second page of this document if for overflow from the first page if there are many barns being sampled.
    • List the barn or house ID followed by the number of tubes submitted for that barn/house if unique sample ID barcodes are not used.
  • Unique sample ID barcodes are encouraged for each tube. List the House/Barn ID on the line and place a duplicate barcode sticker to the one on the tube in the corresponding larger box.
  • If Post C&D, List Tube # on sample site: This information will be provided to you by BOAH during the process of cleaning and disinfection if the site being tested was affected.

Revision date:

For questions or clarifications, email addlhpai@purdue.edu or call 765-494-7440.