IOWA US SHIP Enrollment Form

US SHIP Participant Information (Swine Owner)

Business or Company Name(Required)

Contact Name(Required)

First Last

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone Number(Required)

Email(Required)

Additional Contact Information*

*For US SHIP Participant enrolling multiple sites, Site Owner contact and optional Additional Contact for each site will need to be listed on an attached Multi-Site Enrollment spreadsheet. Download that spreadsheet here.

Site Owner same as Swine Owner

Site Owner same as US SHIP Participant (Swine Owner)

Site Owner — Business/Company Name

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Email

Additional Contact (i.e., site manager, caretaker, etc.)

Phone

Email

Preferred Additional Contact

Site Owner

Additional Contact

Premises (Site) Information

Multiple sites

I am enrolling multiple sites, and all site information is contained on the attached Multi-Site Enrollment spreadsheet.

File(Required)

Accepted file types: xlsx, Max. file size: 256 MB.

Premises Identification Number (PIN)(Required)

Common Name of Site (if different than Swine Owner Name)

911 Address of Site

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

GPS Coordinates (Decimal Degrees), if 911 Address is not provided

Latitude Longitude

Site Type(Required)

Boar Stud — Production site with mature boars that distribute semen to other production sites.

Untitled

Breeding Herd — Production site with breeding females and house ≥ 1,000 breeder or feeder swine. (e.g., breed-to-wean, breeding/gestation or farrowing only, with or without on-site gilt isolation/grow-out)

Untitled

Growing Pigs — Production site with ≥ 1,000 feeder swine (nursery, grower, or finisher)

Untitled

Farrow to Feeder/Finish — Production site with breeding females, grow feeder swine for purposes other than breeding stock replacement for this particular farm site, and house ≥ 1,000 breeder or feeder swine.

Untitled

Small Holding — Production sites with ≥ 100 and < 1,000 total breeder or feeder swine.

Untitled

Non-Commercial — Production sites with < 100 pigs.

Untitled

Packing Plant — A facility that slaughters pigs.

Site Capacity(Required)

These statements apply to all sites listed for multi-site enrollment.

Veterinary–Client–Patient Relationship

Veterinary involvement(Required)

I affirm that I have a relationship with a USDA Category II Accredited Veterinarian for the enrolled site(s) and have involved them in US SHIP participation discussion.

More than one vet

I am enrolling multiple sites with more than one veterinarian and/or clinic, and have included all vet information on the attached Multi-Site Enrollment spreadsheet.

Veterinarian Name(Required)

First Last

Veterinary Clinic or Business Name

Phone

Email

Biosecurity

Garbage feeding(Required)

I affirm that the feeding of swill, garbage, or table waste that has the potential to contain meat products is strictly prohibited on the site(s) enrolled on this form.

Site visitors(Required)

I affirm that the enrolled site(s) have a biosecurity plan regarding site visitors that have been exposed to livestock, feral/wild pigs, or slaughter facilities in ASF/CSF/FMD positive regions or countries abroad. This includes observing five days of downtime before entering the facility and wearing PPE on the site.

Survey completed(Required)

I agree to complete a survey of the high-level biosecurity practices on the enrolled site(s) upon completion of this form. (Survey link will be emailed to you.)

Traceability

Records of movements(Required)

I affirm that I maintain records of the intrastate and interstate movements of live swine into and out of the site(s) enrolled on this form.

IDALS test exercise(Required)

I agree to demonstrate competency of live animal movement records by submitting at least 30 days of movement information to the Iowa Department of Agriculture and Land Stewardship (IDALS) in a test exercise coordinated within one year of enrollment.

Sampling and Testing (Disease Surveillance)

Evolving requirements(Required)

I acknowledge that there is no sampling and testing requirement for the initial 12-month period of the US SHIP program, and I understand this will change as the program evolves.

Delegate participation(Required)

I acknowledge that the US SHIP program standards will evolve over time and that delegate participation is important for the quality of the US SHIP program.

Notify IDALS of site changes(Required)

I acknowledge it is my responsibility as a program participant to meet or exceed the requirements for the US SHIP certifications and notify IDALS with any changes to the site(s) enrolled. (i.e., changes to site contact information, if the site(s) are no longer enrolled in the program, etc.)

Information complete and correct(Required)

I declare that I have completed this enrollment form understanding the US SHIP program standards and have made a good-faith effort that the information provided is true, correct, and complete.

Program Participant Name(Required)

First Last

Date(Required)