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Manual of Common Diseases and Parasites of Wildlife in Northern British Columbia |
| DISEASE SURVEILLANCE and specimen history form |
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Reporting the occurrence of wildlife disease is important. Complete this form and submit to the nearest Ministry office. Please also submit a copy of a completed form if biological samples are collected. Submitter’s name:____________________________________________________________________ Affiliation: ___________________________________________________________________________ Address: ____________________________________________________________________________ Collector's Name: ____________________________________________________________________ Affiliation: ______________________________________________________________________ Address:________________________________________________________________________ Telephone:_____________________________ E-mail:______________________________________ Date collected: ____________________________________________________________________
Specific die-off location: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Region:_____________________________________________________________________________ UTM: ______________________________ Lat./Long._______________________________________
Legal description:___________________________________________________________________
Method of collection : [found dead, euthanized (describe method) etc.] ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Environmental factors:
(Record conditions such as storms, precipitation, temperature changes, or other
changes that may contribute to stress.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Disease onset
: (The best estimate of when the outbreak started.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Species affected
: (The diversity of species affected may provide clues to the disease involved.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Age/sex
: (Any selective mortality related to age and sex.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Morbidity/mortality
: (Ratio of sick animals to dead animals.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Known dead
: (Actual pickup figures.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Estimated dead:
(Consider removal by scavengers or other means.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Clinical signs:
(Any unusual behaviour and physical appearance of affected animals.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Population at risk
: (Number of animals in the area that could be exposed to the disease.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Population movement:
(Recent changes in the number of animals on the area and their source or
destination, if known.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Problem area description:
(Land use, habitat types, and other distinctive features.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
Comments:
(Additional information/observations that may be of value such as past occurrences of disease in area.) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
The above adapted from: U.S. Department of the Interior and U.S. Geological Survey. 2001. Field manual of wildlife diseases: general field procedures and diseases of birds. M. Friend and J. C. Franson (Tech. Eds.), E. A. Ciganovich (Editor). Biological Resources Division Information and Technology Report 1999–001. U.S. Department of the Interior and U.S. Geological Survey, Washington, DC. |
