Record of Animal Disease Event (ROADE)

To apply for funding under the National Significant Disease Investigation Program (NSDIP) please complete and submit the Record of Animal Disease Event (ROADE) form.

Questions marked with an asterisk (*) are mandatory.

Practitioner Name *

Private vet or VO

Submitter Address *


Postcode *


Practitioner Phone *


Practitioner Business Phone *


Practitioner Email * (make sure it is correct)


Date of Investigation *

Date of Investigation Required Field Date

Date of first case *

Date of first case Required Field Date

Date of most recent case *

Date of most recent case Required Field Date

Property Owner Name *


Property Contact Name

(if different than owner)

PIC *

Property Identification Code

Trading/Property Name


Farming System *

(eg dairy, intensive broiler)

Property Primary Phone *


Property Secondary Phone


Property Email (make sure it is correct)


Species *


Breed *


Sex *


Animal Location

(address)

GPS Coordinates Latitude


GPS Coordinates Longitude


Number Examined *


Number at Risk *


Number of Sick *


Number of Dead


History and predisposing factors

1. Problem
2. Animal characteristics
3. When
4. Where
5. Management
6. Environment

Clinical/Necropsy Findings *


Laboratory Numbers

(if a follow up)

Samples

Blood smear

EDTA

Heparin

Plain blood

Aq. Humour

Faeces

Urine

Swab

Fresh tissue

Fixed Tissue

Plant

Ingesta

Specify your own value:

Laboratory Results to date


Primary Syndrome

Abortion/Stillbirth

Acute febrile disease

Alimentary signs not diarrhoea

Circulatory/Anaemia/Oedema

Congenital Abnormalities

Diarrhoea

Found Dead

Genital lesions

Illthrift/weight loss

Infertility

Jaundice

Lameness

Lymphadenopathy

Mastitis

Nasal discharge

Neurological signs + organs of special sense

No suitable syndrome (provide further detail in comments)

Oral lesions/salivation

Production drop (not mastitis)

Pruritis

Respiratory signs

Skin lesions

Sudden Death

Urinary Tract/Haematuria

Weakness/Depression

Estimated $ Cost to Producer


Recommendations to Producer


Recommendations to Biosecurity Tasmania


Additional Comments

In Progress

Please wait, your form is being submitted. The page will be redirected once the form is processed.

Privacy statement

Information from this form will be used by NRE Tas to operate the National Significant Disease Investigation Program (NSDIP) which benefits the livestock and agricultural sectors within Tasmania. In appropriate circumstances selected data such as name, address, phone and PIC may be provided to the Australian Animal Health Laboratory, Animal Health Australia, National Livestock Identification Scheme database, abattoir, veterinary practitioners and stock squad. Your basic personal information may also be disclosed to other public sector bodies where necessary for the efficient storage and use of the information. If you do not provide complete and accurate information you may be in breach of the Animal Health Act 1995, and effective tracing of animals that supports domestic and international trade may be jeopardised. Personal information will be managed in accordance with the Personal Information Protection Act 2004. You may access your records through any regional office of NRE Tas. You may be charged a fee for this service. For more information please contact the Animal Biosecurity& Welfare Branch (03) 6165 3777.