Department of health and human services

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ANIMAL HEALTH AND SHIPPING CERTIFICATE


DATE

Health

Certification:


The animals described hereon have been examined and found to be free of evidence of disease except as may be stated below. This certification is based on visual observation. Unless otherwise stated, no laboratory tests have been performed.


Certification of Air

Temperatures:

I hereby certify that the animals in this shipment are not, to the best of my knowledge, acclimated to air temperatures lower than 7.20C (450F) or greater than 29.40C (850F).

Examining Veterinarian

Shipper’s

Statement:


The animals described hereon:


 have not been inoculated with live microorganisms.

 have been inoculated with live ,

microorganisms, which are not known to be infectious to man or other animals except

under experimental conditions.


Certification

For Animal

Enclosure:


I hereby certify that the (number) primary enclosure(s) which are used to transport the animal(s) in this shipment complies (comply) with USDA standards for primary enclosures.

Consignor


Shipment Contains:

NUMBER

SPECIES

STRAIN

SEX

COLOR













































From:

Name




Laboratory


Institute/Center




NATIONAL INSTITUTES OF HEALTH (provide specific address)



To:





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