Get the free Avian Influenza Contact Surveillance Form - dhhr wv

This form is used to track and monitor individuals who are at risk of exposure to avian influenza, documenting their clinical signs and medication adherence.

How to fill out avian influenza contact surveillance

How to fill out Avian Influenza Contact Surveillance Form

1. Obtain the Avian Influenza Contact Surveillance Form from the relevant health authority or website.
2. Fill in the personal information section with your name, address, phone number, and email.
3. Provide your occupation, specifying if you work with birds or poultry.
4. Indicate any recent travel history to areas affected by avian influenza.
5. List any contact with poultry or wild birds in the past 30 days.
6. Report any signs of illness you or your contacts have experienced.
7. Review the completed form for accuracy and clarity.
8. Submit the form via the specified method (online, email, or in-person) to the relevant health authority.

Who needs Avian Influenza Contact Surveillance Form?

1. Individuals who have had direct contact with birds or poultry.
2. Veterinarians and animal health workers who handle birds.
3. People traveling to regions with reported avian influenza cases.
4. Researchers working with avian species.
5. Poultry farm workers and managers.

People Also Ask about

What is the National Wildlife Disease Program?

The primary objectives of the national H5/H7 AI surveillance system are to: Detect the presence of H5/H7 AI in domestic poultry populations if the prevalence among premises within a State is 1 percent and the prevalence within an infected premises is 25 percent.

What are the CDC guidelines for avian influenza?

People should avoid direct contact with wild birds and other animals that could be infected with avian influenza A viruses. If you must have direct/close contact with infected or potentially infected birds or other animals, wear recommended personal protective equipment (PPE).

What is the Aphis Wild bird surveillance Program?

Through our ongoing wild bird surveillance program, APHIS collects and tests large numbers of samples from wild birds in the North American flyways. It is not uncommon to detect avian influenza in wild birds, as avian influenza viruses circulate freely in those populations without the birds appearing sick.

What is the Aphis in the US?

Animal and Plant Health Inspection Service (APHIS) The Animal and Plant Health Inspection Service (APHIS) protects and promotes U.S. agricultural health, regulates genetically engineered organisms, administers the Animal Welfare Act, and manages wildlife damage.

What is influenza surveillance?

Influenza surveillance is the collection, compilation and analysis of information on influenza activity in a defined population.

What is the difference between LPAI and HPAI?

The National Wildlife Disease Program promotes safe agricultural trade by protecting the health of humans, animals, plants, and ecosystems and reducing levels of incurred losses to agricultural and natural resources.

For pdfFiller’s FAQs

What is Avian Influenza Contact Surveillance Form?

The Avian Influenza Contact Surveillance Form is a document used to monitor and track individuals who have had contact with birds or environments potentially affected by avian influenza.

Who is required to file Avian Influenza Contact Surveillance Form?

Individuals who have had direct contact with birds, poultry workers, veterinarians, or others who may have been exposed to avian influenza are required to file this form.

How to fill out Avian Influenza Contact Surveillance Form?

To fill out the form, individuals should provide personal information including their name, contact details, a description of their contact with birds, and any symptoms experienced. It is essential to complete all sections accurately and submit it to the relevant health authority.

What is the purpose of Avian Influenza Contact Surveillance Form?

The purpose of the form is to help public health officials monitor potential outbreaks, identify at-risk individuals, and implement necessary public health interventions.

What information must be reported on Avian Influenza Contact Surveillance Form?

The form must report personal identification details, contact history with birds, dates of exposure, health symptoms, and vaccination history if applicable.