VETERINARY REPORT CONFIDENTIAL EVENT INFORMATION Event Venue & Country Start Date End Date Event Code (classes and categories)* * IMPORTANT: Please note that normally only one Veterinary Report is required per Event/ per Veterinary Delegate, regardless of the number of classes/ categories (for multi-discipline Events where different (Foreign) Veterinary Delegates are appointed please each (Foreign) Veterinary Delegate) must submit their Report. (FOREIGN) VETERINARY DELEGATE Name FEI ID Please ensure all personal information in the FEI Database is up to date at all times. THE REPORT MUST BE COMPLETED AND SUBMITTED BY THE (FOREIGN) VETERINARY DELEGATE WITHIN 72 HOURS OF THE EVENT TO: Fédération Equestre Internationale HM King Hussein I Building, Chemin de la Joliette 8, CH1006 Lausanne Email: dominique.rochat@fei.org Fax: + 41 21 310 47 60 Any queries, questions or comments should be direct to Mrs Dominique Rochat. FATALITY AND CATASTROPHIC INJURY (Veterinary Regulations articles 1038-40) The Fatality Report/section of this Veterinary Report must be submitted within 12 hours of the incident. Samples must be obtained in accordance with the EADCMP for testing. A post-mortem must be performed, the FEI will cover expenses up to Euro 500 for gross post-mortem only. Please ensure details for the postmortem facility are provided to the FEI, in addition to the examination reports, in complete confidentiality. Note that any other associated costs are at the expense of the PR. In accordance with Veterinary Regulations, the Official Veterinarian completing this report must be in possession and have a working knowledge of the following FEI rules and regulations: - Statutes: 23rd Edition, effective 7 November 2013 - General Regulations: 23rd Edition, 1 January 2009, updates effective 1 January 2014 - Veterinary Regulations: 13th Edition, 1 January 2014 - Equine Anti-Doping and Controlled Medication Regulations (EADCMR), 1st Edition, updates effective 1 January 2014 - All relevant discipline rules In addition to the following FEI Codes of Conduct: - for the Welfare of the Horse - towards Fair Play - towards Environment & Sustainable Development All information contained in this Veterinary Report is CONFIDENTIAL Page 1 of 13 VETERINARY REPORT CONFIDENTIAL 1. FEI Veterinarians 1.1 Official Veterinarians (Veterinary Commission/ Delegate, Holding Box, Testing/ Examination/ Measuring Veterinarians) FEI ID 1.2 Name Role (e.g. President, FVD, Assistant) Dates Present Permitted Treating Veterinarians (Athlete’s Private Veterinarians, Team Veterinarians, Treating Veterinarians etc) FEI ID Name Role Veterinary Services Manager All information contained in this Veterinary Report is CONFIDENTIAL Page 2 of 13 VETERINARY REPORT CONFIDENTIAL 1.3 Other Was the Organising Committee compliant with the requirements of VRs article 1022 regarding the appointment of FEI Veterinarians? yes no yes no Please provide comments, if any: Had any of the above named Official Veterinarians worked as a Veterinary Delegate or part of the Commission at this Event in the past 3 years? If yes, please provide details: All Veterinarians, Official and Permitted Treating, must carry their FEI ID card at all times when attending Events and make themselves known to the Veterinary Commission/ Delegate prior to working in any veterinary capacity during an Event. Remarks regarding ID Cards: In accordance with Veterinary Regulations Article 1013.5, the Veterinary Commission/Delegate should arrange a meeting with all other veterinarians present. Please provide details below and/ or append a short report of this meeting. Was a meeting organised with the team vets? yes no yes no Meeting Details: Were issues raised? If yes, please describe the issues? 2. Stables 2.1 Stable and Stable Area Requirements Was the Organising Committee in compliance with the Stables and Stable Area Requirements, as set forth in VRs article 1023? yes no Comments on Stables and Stable Area Requirements: 2.2 Minimum Stable Security (required for all Events, VRs article 1023, IV) Is there an effective security system to prevent unauthorised persons from entering the Designated Stable Area? yes no Is security at night sufficient? yes no Comments: All information contained in this Veterinary Report is CONFIDENTIAL Page 3 of 13 VETERINARY REPORT CONFIDENTIAL 2.3 Stable Biosecurity (required for all Events, VRs article 1023, IV) Were the stables organised in accordance with the stabling arrangements specified in article 1023, 10e? yes no Comments: 2.4 Other Stable Requirements DESCRIPTION Testing boxes Treatment boxes Isolation stables and facilities How many? Sufficient number? Yes/No Suitable/ fit for purpose? Yes/No Comments on Stable Area Requirements (if insufficient numbers of Testing, Treatment or Isolation stables were available, please advise how many should be provided for future Events): 2.5 Additional Stable Security (VRs article 1023, V) Was additional Stable Security required for this event? yes no If required, was the Stable Security in accordance with VRs? yes no Comments: 3. Veterinary Services & Arrangements 3.1 Veterinary Services On arrival at an Event please ensure that all veterinary services and requirements are adequate (as defined in VRs article 1023-1024). Please provide information regarding changes that were required or recommended to the Organising Committee, if any: If the provision of veterinary services were insufficient or if you have suggestions for the future please provide your opinion here (otherwise leave blank): 3.2 Biosecurity Were all provisions and requirements for Biosecurity provided by the Organising Committee, in accordance with VRs article 1026? yes no If biosecurity provisions were not sufficient, please provide details: All information contained in this Veterinary Report is CONFIDENTIAL Page 4 of 13 VETERINARY REPORT CONFIDENTIAL 4. Examination on Arrival 4.1 Name of Veterinarian(s) completing the Examination on Arrival (ensure FEI ID and other information is entered above in section 1.1): Horses arriving at the venue Horses admitted to the venue Horses arriving with Injuries Horses sent to Isolation facility Horses not presenting at the Horse Inspection Please provide information regarding injuries, illness and isolation in the relevant sections below. 4.2 Details of any horses entering the venue that are not competing: 5. Passport control 5.1 Passports Number of passports presented: 5.2 Irregularities Please list the details of all passport irregularities below: Horse Passport Number / FEI ID Horse Name Person Responsible (PR) PR FEI ID NF Violation Sanction / Penalty (CHF) All information contained in this Veterinary Report is CONFIDENTIAL Page 5 of 13 VETERINARY REPORT CONFIDENTIAL 6. Horse Inspection(s) 6.1 Were the conditions for the Horse Inspection in accordance with the VRs article 1024 & 1033? Surface type: yes no Comments: 6.2 Please complete a separate subsection below for the Horse Inspection for each class – this information is essential for later data analyses. Information regarding injuries or findings of the clinical examination performed in the Holding Box, must be indicated in the section below reporting “Injuries”. A. HORSE INSPECTION FOR COMPETITION/ CLASS: Please ensure competition/ class details are entered. Inspection Panel participants: First Horse Inspection: Horses Presented Holding Box Not Accepted Withdrawn Total accepted (after Holding Box) Re-Inspection Horses presenting for Re-Inspection following First Horse Inspection: Horses Not Accepted AFTER Presented Holding Box Accepted Withdrawn Holding Box Details for Horses Not Accepted OR Withdrawn: Horse Passport Number / FEI ID Horse Name Holding Box (yes/no) Withdrawn OR Not Accepted Reason for Withdrawal or Not Accepted All information contained in this Veterinary Report is CONFIDENTIAL Page 6 of 13 VETERINARY REPORT CONFIDENTIAL B. HORSE INSPECTION FOR COMPETITION/ CLASS/ SECOND INSPECTION: Please ensure competition/ class/ Second Horse Inspection details are entered. Inspection Panel participants: First Horse Inspection: Horses Presented Holding Box Not Accepted Withdrawn Accepted AFTER Holding Box Re-Inspection Horses presenting for Re-Inspection following First Horse Inspection: Horses Not Accepted Accepted AFTER Presented Holding Box Withdrawn Holding Box Details for Horses Not Accepted OR Withdrawn: Horse Passport Number / FEI ID Horse Name Holding Box (yes/no) Withdrawn OR Not Accepted Reason for Withdrawal or Not Accepted For competitions where a Second Inspection occurs, please complete a second Horse Inspection section, marking it as the “Second Horse Inspection” in the “class/ competition” comment box. For Events where further competition/ classes or inspections occur, please append “Additional Horse Inspection Form” information. Number of Additional Horse Inspection Forms appended: 7. Isolation Please provide information regarding any Horses stabled in the Isolation Boxes: Horse Date of Passport Horse Name Stable Reason for isolation Number Isolation Number /FEI ID All information contained in this Veterinary Report is CONFIDENTIAL Page 7 of 13 VETERINARY REPORT CONFIDENTIAL 8. Appointed FEI Approved Laboratory Please indicate the designated FEI Approved Laboratory (select ONLY ONE): Central Laboratory: HFL Sport Science, Newmarket, UK Reference Laboratories: Laboratoire des Courses Hippique, Paris, France The Hong Kong Jockey Club, Hong Kong USEF Equine Drug Testing & Research Laboratory, USA Australian Racing Forensic Laboratory 9. Veterinary Forms 9.1 Total number of Veterinary Forms received by Veterinary Delegate from entire Event (these must be appended to this Veterinary Report): 9.2 Please provide numbers of each type of Veterinary Form received in the table below: Veterinary Form 1 Veterinary Form 2 Emergency Treatment Altrenogest in mares Veterinary Form 3 Veterinary Form 4 Supportive Therapies and Treatment Self-Declaration substances 10. Equine Anti-Doping and Controlled Medication Program 10.1 Was an EADCMP Testing Veterinarian present? yes no yes no 10.2 Was the testing procedure conducted in accordance with the VRs, chapter VI? yes no Did the Testing Veterinarian raise any conflict of interest issues? yes no 10.3 To your knowledge have any of the Horses presented for testing under the EADCMP received medication, i.e. have any Veterinary Forms been received (General Regulations Article 146)? yes no If yes, please provide details in the table (10.4) below and append Veterinary Forms to this report. All information contained in this Veterinary Report is CONFIDENTIAL Page 8 of 13 VETERINARY REPORT CONFIDENTIAL 10.4 Please provide details in the table below of any Veterinary Forms received for Horses presented for EADCMP testing listed in 10.7: Horse Passport Number /FEI ID Horse Name Veterinary Form Attached to this Report (Yes/No) 10.5 Please provide details in the table below of all samples collected (attach additional pages if necessary). It is of the utmost importance that you enter the relevant seal numbers in the space reserved and attach to your report the original sampling forms or cards for the legal follow-up. Please send the FEI section of the sampling forms (signed by the Person Responsible) with this report. Horse Passport Number /FEI ID Horse Name Person Responsible NF Sample Nº Blood Urine Other Method of Selection Obligatory (winner), Targeted Random, All information contained in this Veterinary Report is CONFIDENTIAL Page 9 of 13 VETERINARY REPORT CONFIDENTIAL All information contained in this Veterinary Report is CONFIDENTIAL Page 10 of 13 VETERINARY REPORT CONFIDENTIAL 11. Horses Injuries & Illness Please provide all information regarding injuries and illness in the table below. Horse FEI ID Name of horse If withdrawn, when? Holding Box etc Reason for withdrawal (describe area of injury and tentative diagnosis) 12. Horses Fatalities Please provide information regarding any fatality occurring and ensure this information is reported to the FEI Veterinary Department within 12 hours of the incident. Horse FEI ID Name of horse Describe Incident Euthanasia agents used, if any EADCMP Samples Taken (Blood & Urine: Yes/ No) Post Mortem facility details All information contained in this Veterinary Report is CONFIDENTIAL Page 11 of 13 VETERINARY REPORT CONFIDENTIAL Please provide any additional information or comments here (e.g. previous history, lameness etc): 13. FOR ENDURANCE ONLY 13.1 Number of horses Eliminated (at Vet Gate) for: Lameness: - Tendons - Suspensory - Foot Metabolic: - Dehydration - SDF - Colic/Diarrhea - Exhaustion - Myositis - Cardiac 13.2 Number of horses receiving treatment: 13.3 Number of horses receiving rehydration treatment: 13.4 Other medication used for treatment (add page if required): 13.5 Number of vet cards collected: Remarks: 13.6 for the following information, add pages if required Number of supporting Leg Injuries (e.g. tendons, ligaments)*: Fractures (please specify)* : Rhabdomyolisis*: Rehydration therapy*: Medication Forms*: (*: Note numbers of horses here; individual horses + reason for withdrawal on reserve side) Comments: Climatic conditions (pref. WBGT index): All information contained in this Veterinary Report is CONFIDENTIAL Page 12 of 13 VETERINARY REPORT CONFIDENTIAL 14. Comments, Follow-up & Improvements (all) Please give a short comment on your general impression of the event: Does further follow-up action need to be taken with the Event Organiser? Yes No Yes No Yes No If yes: Please briefly describe the issue(s) to be followed up (refer to the relevant section in the report for details) Has the Organiser agreed to undertake the follow-up? If yes, please provide details: Do you have any additional recommendations for future improvements to the event? If yes: Please give a short description of areas for improvements and how they could be achieved. PLEASE SUBMIT THIS REPORT VIA EMAIL to Dominique.Rochat@FEI.org to facilitate the administration and to protect the environment. All information contained in this Veterinary Report is CONFIDENTIAL Page 13 of 13