dah-fish-2803 (rev.10/07) –Previous
1
versions should be destroyed
Department Use Only
SUBMIT ORIGINAL WITHIN 7 DAYS AFTER ISSUED:
Wisconsin Department of Agriculture, Trade and Consumer Protection
Division of Animal Health, PO Box 8911, Madison, WI 53708-8911
Telephone: 608-224-4872 Fax: 608-224-4871
Date of Inspection
______________
Fish Health Certificate s. ATCP 10.65, Wis Adm. Code
Date Issued:
________________
A FHC cannot be issued until
test results are obtained
See page 4 for required certificate contents based on movement and fish type
Fish Source Information
Fish Farm Name
Owner or Manager Name
Fish Farm Registration #
Fish Farm Address
Business Address
Premises Registration #
Type of Water Supply (Check all that apply)
Lake or impoundment
Stream
Spring
UV treated
Source of Fish
Wild
Type of Fish Health Certificate (FHC)
Annual Fish Farm FHC (Expires 12 months from date issued)
Lot FHC (Expires 30 days from date issued)
Parameters Assessed
A minimum of 20 fish of each species must be necropsied & examined
Obtained as
Farmed
Species1
Lot #
Age2
# in Lot
Eggs (E) or
(F) or
Fish (F)
Wild (W)
from
Lot #
Age2
# in
Lot
Avg
LN
Avg
WT
4
Sampling
Date
3
Number Sampled (Line 1) and Results (Line 2)
Eyes
Skin
Fins
Gills
Liver
Kidney
Spleen
Fat
Muscle
5
Test/Exams – See bottom Pg 3 for accepted test methodology
A minimum of 60 fish of each species, age and class must be tested
Species1
Free of fish
Hatchery
Fish Health Assessment
Laboratory Testing
Zip
Enclosed
Well
Farmed
(F) or
Wild (W)
Number Sampled (Line 1) and Results (Line 2)
Viral Hemorrhagic
Septicemia
Whirling Disease
Infectious Hematopoietic
Necrosis
White Sturgeon
Iridovirus
Other:
Other:
Attach copies of laboratory test results required. (ATCP 10.65)
If additional space is needed in order to record results of examination and/or laboratory tests, attach dah-fish-2803CONT (rev.10/07)
Some of the information you provide on this Fish Health Certificate is CONFIDENTIAL, as provided by s. 95.60(7), Wis. Stats. and not subject to Open Records requests under s 19.35, Wis.
Stats., except as the department determines is necessary to protect fish health or prevent the spread of disease.
2
Standard Species Abbreviations
General Species
LIR
Livebearer
SAB
Smallmouth buffalo
MCS
Miscellaneous warm water
SAR
Sauger
MOE
MUW
Mooneye
Mudminnow
SCS
Spring chinook salmon
Fathead minnow
GAR
Gar
NOP
Northern pike
SOS
SPB
Sockeye salmon
Spotted bass
Bigmouth buffalo
GIT
Gila trout
GOF
Goldfish
Other catfish
Ohrid trout
Striped bass
Brook trout
OCF
OHT
STB
BKT
STK
Stickleback
BLB
Black bullhead
GOS
Golden shiner
OSA
Other salmonid
BLGHYB
BLP
BON
CAP
DAR
DOV
DOVBKT
Hybrid bluegill
Blue pike
Bowfin
Carp
Darters
Dolly varden
Dolly varden x
brook trout
Coho salmon
GOT
GRC
GSF
KIH
KOE
LAS
Golden trout
Grass carp
Green sunfish
Killifish
Kokanee
Landlocked Atlantic salmon
OSF
OTM
OTP
OTS
PAH
RBTSTT
Other sunfish
Other minnow
Other pike
Other sucker
Paddlefish
Rainbow trout x steelhead trout
STN
STT
Sturgeon
Steelhead trout
SVC
WAESAR
WAM
WCF
WCS
Silver carp
Walleye x sauger
Warmouth
White catfish
Winter chinook salmon
LAT
Lake trout
RSF
Redear sunfish
WSK
White sucker
LAY
Lamprey
AMP
Amur pike
CUT
ARG
Arctic grayling
ATS
Atlantic salmon
FCF
FCS
Flathead catfish
Fall chinook salmon
BCF
BCFCCF
Blue catfish
Blue catfish x
channel catfish
FHM
BIB
COS
Cutthroat trout
VHS Susceptible Species (www.aphis.usda.gov/vs/aqua/pdf/vhs_susceptible_species.pdf)
Black crappie
FRD
Freshwater drum
RB
BLG
Bluegill
BNM
Bluntnose minnow
GZS
Gizzard shad
RG
LWF
Lake whitefish
SHRH
BNT
BRT
Brown trout
LMB
Largemouth bass
SRH
Silver redhorse
Burbot
MUE
Muskellunge
SMB
Smallmouth bass
BRB
CCF
Brown bullhead
PK
Pike
STS
Spottail shiner
Channel catfish
PSD
Pumpkinseed
T-P
Trout-perch
CHS
Chinook salmon
RBT
Rainbow trout
WAE
Walleye
EMS
Emerald shiner
RHS
Redhorse sucker
WHB
White bass
BLC
Rock bass
WHP
White perch
Round goby
YPC
Yellow perch
Shorthead redhorse
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dah-fish-2803 (rev.10/07) –Previous
versions should be destroyed
Remarks
Drug and Chemical History:
Skin Scrape:
Parasites present? Y / N
Gill Mount:
Parasites present? Y / N
General Comments:
What kind:
What kind:
Qualified Fish Health Inspector6 Information
Name
Address
Telephone
License # (if applicable)
City , State, Zip code
I certify that the above described fish have been inspected by me and that they are not showing visible signs of contagious or infectious disease (except where noted). The laboratory test results are indicated and
attached. I certify that this certificate includes ____ Continuation Sheets which are hereby part of the certificate. (insert a ‘0’ if none included)
Signature of Qualified Fish Health Inspector
Date
1
Use standard abbreviations (see page 2)
2
For hatchery fish, give the age in months; for feral fish, use one of the following:
E=eggs or fry
F=fingerlings
Y=yearlings
B=older fish
3
All Parameters assessed in the Fish Health Assessment should be noted as either ‘N’ for normal, or if abnormal, number and record findings under general comments. Fat is
measured as the amount of organs posterior to the liver that are covered by fat, 1=none, 2 =<25%, 3= 25-50%, 4=50-75%, 5=75%+
4
Accepted Testing Methodologies:
All laboratory testing required on the FHC must be performed using either the USFWS/AFS-FHS Standard Procedures for Aquatic Animal Health Inspections as detailed in
the Suggested Procedures for the Detection and Identification of Certain Finfish and Shellfish Pathogens, 2005 edition, American Fisheries Society, Fish Health Section,
Bethesda, Maryland: OR The World Organization for Animal Health (OIE) Manual of diagnostic Tests for Aquatic Animals, Fifth Edition (2006), OIE, Paris, France.
A fish health certificate shall include test results from a qualified laboratory to confirm those test results required by the certificate form. A qualified laboratory is one of
the following: a) a lab approved by the federal bureau for purposes of disease testing related to interstate movement of fish or fish eggs. b) a lab approved by DATCP for
purposes of disease testing of fish or fish eggs. c) A federal or state veterinary diagnostic laboratory. (s. ATCP 10.67(2), Wis. Adm. Code.)
5
See page 4 for tests required based on fish movement and fish type.
6
Qualified Fish Health Inspector must be one of the following: a) A WI certified veterinarian who has completed a training program approved by DATCP. b) A fish health
inspector or pathologist certified by the American Fisheries Society that has taken a training program approved by DATCP. c) For inspection and sampling outside of WI, any
accredited veterinarian. (s. ATCP 10.67 (1) Wis. Adm. Code)
For purposes of this certificate a laboratory test result is rebuttably presumed to be valid if the department or the federal bureau has approved or certified the laboratory to perform that
type of test.
Any person affected adversely by any DATCP action on this FHC may petition the Department for a hearing under s. ATCP 1.06, Wis. Adm. Code. The request shall identify the
action on which a hearing is sought, the grounds for the hearing request, and the relief sought. Hearings shall be granted or denied within 20 days following the filing of a complete
request with DATCP.
4
REQUIRED TESTS
*A “wild source” includes a wild source in this state or outside this state. Fish and fish eggs imported from other states (including bait fish and fish eggs)
must also comply with import requirements under s. ATCP 10.62. Species that the federal bureau has found to be susceptible to viral hemorrhagic
septicemia are listed at http://www.aphis.usda.gov/vs/aqua/pdf/vhs_susceptible_species.pdf.
The Fish Health Assessment portion of the fish health certificate is required to be completed for all Fish Health Certificates.
Laboratory Tests required for importing any live fish or fish eggs into Wisconsin:
Infectious hematopoietic necrosis, viral hemorrhagic septicemia (VHS) and whirling disease (Myxobolus cerebralis) if an import shipment covered by
the health certificate includes salmonids.
White sturgeon iridovirus if an import shipment covered by the health certificate includes sturgeon.
Viral hemorrhagic septicemia (VHS) if an import shipment covered by the health certificate includes fish or fish eggs from a state or province where
that disease is known to occur.
Tests required for stocking live fish or fish eggs into waters of Wisconsin:
Whirling disease (Myxobolus cerebralis) if a shipment covered by the health certificate includes salmonids.
Viral hemorrhagic septicemia (VHS) if a shipment covered by the health certificate includes any of the following fish or fish eggs of a species that
the federal bureau has found to be susceptible to viral hemorrhagic septicemia (VHS):
o Fish or fish eggs collected from a wild source* within the 12 month period immediately preceding the shipment.
o Fish or fish eggs kept at a fish farm that received fish or fish eggs of any species collected from a wild source within the 12 month period
immediately preceding the distribution date.
Tests required for farm to farm movement of any live fish or fish eggs in Wisconsin: (see Exception below)
Viral hemorrhagic septicemia (VHS) if a shipment covered by the health certificate includes any of the following fish or fish eggs of a species that
the federal bureau has found to be susceptible to viral hemorrhagic septicemia (VHS):
o Fish or fish eggs collected from a wild source within the 12 month period immediately preceding the shipment.
o Fish or fish eggs kept at a fish farm that received fish or fish eggs of any species collected from a wild source within the 12 month period
immediately preceding the distribution date.
Tests required for wild source live fish or fish eggs distributed for use as bait:
Viral hemorrhagic septicemia (VHS) if a shipment covered by the health certificate includes any of the following fish or fish eggs of a species that
the federal bureau has found to be susceptible to viral hemorrhagic septicemia (VHS):
o Fish or fish eggs collected from a wild source within the 12 month period immediately preceding the shipment.
o Fish or fish eggs kept at a fish farm that received fish or fish eggs of any species collected from a wild source within the 12 month period
immediately preceding the distribution date.
EXCEPTION: A fish health certificate is not required for the movement of live fish or fish eggs between fish farms that are registered by the same registrant
provided that the registrant keeps complete records of the movement. This exception applies only during the time period that the DATCP Emergency Rule,
Docket No. 07-R-07, and any extensions thereto, are in effect. (see s ATCP 10.64 (3), Wis. Adm. Code)