TARGETED SURVEILLANCE FOR CLASSICAL SWINE FEVER
MAY 2009 EDITION
1) SENDER DETAILS
Name:
Telephone no:
Designation: State Veterinarian
Private Veterinarian
Animal Health Technician
I hereby certify that the State Veterinarian (See point 2) has been notified of this testing.
Signature: ____________________________________
2) STATE VETERINARIAN DETAILS
Name:
State Vet Area:
Telephone no:
Province:
Fax no:
( Important: The test results will be faxed to the State Vet at this number)
3) SAMPLE DETAIL
Number of samples:
Sender Reference no:
Date of sample collection:
4) OWNER/MANAGER DETAILS
Name:
Telephone no:
5) FARM DETAILS
Farm name/Village:
Local Municipality:
Nearest town or Post Office:
Geographical Location
East
Deg
South
Min
Sec
Deg
Min
Sec
6) MANAGEMENT PRACTICES (Tick appropriate boxes)
Housing system:
Pigs permanently confined
Pigs partially / temporarily confined
Free ranging
General biosecurity:
Intact perimeter fencing
Visitor access control
Dealer/ Speculator
Feed source:
Commercial feed
Self mixed feed
Swill / suspected swill feeding
Pig slaughter:
None
Abattoir
Home slaughter
7) PIG SPECIES SAMPLED ON THE FARM (Tick appropriate boxes)
Domestic pig
European Wild Boar
Bush pig
Warthog
8) CLINICAL SURVEILLANCE (Tick appropriate boxes)
No. of pigs on farm/epidemiological unit:
Sick pigs? Yes
9) TYPE OF SAMPLE SUBMITTED (Tick appropriate boxes)
1) Routine surveillance :
2) Dead pigs:
No
10) SAMPLE SHEET
TUBE
NO:
ANIMAL ID OR OWNER NAME
TUBE
NO:
1
11
2
12
3
13
4
14
5
15
6
16
7
17
8
18
9
19
10
20
ANIMAL ID OR OWNER NAME
11) COMMENTS
DISPATCHING OF SAMPLES
Send samples by courier to:
Onderstepoort Veterinary Institute: Virology Section
100 Old Soutpan Road, Onderstepoort
0110
Any enquiries can be directed to: Dr. Johan Dippenaar
Dr. Grietjie de Klerk
Tel (012) 319 7635
Tel (012) 319 7412
E mail JohanD@nda.agric.za E mail GrietjieDK@nda.agric.za
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