FIMA Form 1994

REPORT OF TUBERCULIN TESTS OF CATTLE
REQUIRED FOR INTRODUCTION INTO THE UNITED STATES
OF RAW MILK AND CREAM UNDER THE FEDERAL IMPORT MILK ACT

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
FOOD AND DRUG ADMINISTRATION
OWNER

DATE OF EXAMINATION

ADDRESS

LOCATION OF HERD

A
N
I
M
A
L

SUBCUTANEOUS
A
G
E

S
E
X

IDENTIFICATION OF ANIMAL
(Accurate description or ear tag number
or registration name and number)

N
O

TEMPERATURE
BEFORE
INJECTION
M

M

M

TIME
OF
INJECTION
M

TUBERCULIN
INJECTION
1
QTY/TYPE
C.C.

TYPE

M

M

M

M

See Reverse for OMB Statement

INTRADERMAL
INJECTION
Type
Quantity
Date
Hour

TEMPERATURE AFTER
INJECTION

M

Form Approved; OMB No. 0910-0212
Expiration Date: June 30, 2012

M

CONCLUSIONS
(healthy,
reactor,
suspect)

2

OBSERVATIONS
hrs

hrs

hrs

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
IF MORE SPACE IS NEEDED USE ADDITIONAL FORMS FDA 1994
CERTIFICATION: I HEREBY CERTIFY THAT I HAVE INSPECTED AND TESTED WITH TUBERCULIN THE
SIGNATURE OF VETERINARIAN

TITLE (Official connection)

ANIMALS ABOVE WITH RESULTS AS STATED.
MAILING ADDRESS (Include ZIP Code)

1. The following symbols may be used to denote the type of tuberculin: B - Bovine; A - Avian; & H - Human.
2. All reactors & suspicious animals must be removed from herd & certificate of owner to that effect given on the other side of this form.

FORM FDA 1994 (8/09)

PREVIOUS EDITION IS OBSOLETE

PSC Graphics (301) 443-1090

EF

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An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

INSTRUCTIONS
Either the subcutaneous or the intradermal test may be used.
Subcutaneous Test - When the subcutaneous tuberculin test is applied,
the chart on the other side of this form shall show that at least 3
temperatures were taken, 2 or 3 hours apart, before the injection of
tuberculin; that at least 6 temperatures were taken 2 hours apart,
beginning 8 hours after the injection; and that the test had run for a period
of not less than 18 hours after injection.
Intradermal Test - When the intradermal test is applied, the chart on the
other side of this form shall show that the last observation was made not
earlier than the seventy-second hour after injection. At least two
observations should be made on animals from infected herds.
Reactions, Subcutaneous Test - A rise of 2 degrees Fahrenheit or more
above the maximum temperature observed prior to the injection of
tuberculin or a temperature above 103.8°F. should be regarded as an
indication of tuberculosis, provided the temperature reaction shows a
characteristic curve. An elevation of temperature higher than 103.8°F.
should also be regarded as an indication of tuberculosis,

even though the curve may not be regarded as typical. Animals that after
injection show a rise in temperature of 2 degrees Fahrenheit, with a
maximum between 103° and 103.8°F., as well as those that show a rise
of less than 2 degrees Fahrenheit, with a maximum temperature of 103.8°
F., are regarded as suspicious reactors.
Reactions, Intradermal Test - Animals that show at the point of injection
swellings, either hard and circumscribed, or soft and infiltrated, with no
distinct line of demarcation, should be classified as reactors to the
intradermal tuberculin test. Such swellings may be of various sizes, from
those hardly perceptible to the naked eye to those as large as the human
fist or larger. The results of observations on individual animals should be
reported on the test record in accordance with the prescribed code of the
country in which the cattle are tested.
Identification of Animals - All animals reported on this chart must be
identified by proper metal ear tags, or registration names and numbers, or
by accurate descriptions.

I HEREBY CERTIFY that I am the owner of the cows described on the other side of this form; that all animals in the herd have been tested,
and that the animals designated as "reactors" and "suspected" as numbers
on this form, have
been permanently removed from the herd and disposed of as follows
I certify further that no milk or cream from such reactors or suspected animals will be introduced into the United States.

(Signed)
(Name of Owner)

FORM FDA 1994 (8/09)

(Address)

(Date)