Form 89-864 Marine Mammal Stranding Report - Level A Data

Marine Mammal Stranding Reports/Marine Mammal Rehabilitation Disposition Report/Human Interaction Data Sheet

Revised Level A form_Revised

Marine Mammal Stranding Report - Level A

OMB: 0648-0178

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0648-0178 can be found here:

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MARINE MAMMAL STRANDING REPORT - LEVEL A DATA

FIELD #:

NMFS REGIONAL #: NATIONAL DATABASE#: (NMFS USE) (NMFS USE)

COMMON NAME: GENUS: SPECIES:

EXAMINER Name: Affiliation:

Address: Phone:

Stranding Agreement or Authority:

CONFIDENCE CODE (Check ONE): □ Unconfirmed - Low □ Confirmed - Minimum □ Confirmed - Medium □ Confirmed – High

INITIAL OBSERVATION □ Same Information for Level A Examination

DATE: Year: Month: Day:

First Observed: □ Beach/Land/Ice □ Floating □ Swimming

LOCATION: State: County: City: Body of Water: Locality Details: Lat (DD): . N

Long (DD): . W

Actual □ Estimated

How Determined: (check ONE)

□ GPS □ Map □ Internet/Software □Other___________________________

CONDITION AT INITIAL OBSERVATION (Check ONE)

1. Alive □ 4. Advanced Decomposition

□ 2. Fresh Dead □ 5. Mummified/Skeletal

□ 3. Moderate Decomposition □ 6. Condition Unknown

LEVEL A EXAMINATION Examined? □ YES □ NO

DATE: Year: Month: Day:

First Examined: □ Beach/Land/Ice □ Floating □ Swimming

LOCATION: State: County: City: Body of Water: Locality Details: Lat (DD): . N

Long (DD): . W

Actual □ Estimated

How Determined: (check ONE)

□ GPS □ Map □ Internet/Software □Other_______________________________

CONDITION AT EXAMINATION (Check ONE)

1. Alive □ 4. Advanced Decomposition

□ 2. Fresh Dead □ 5. Mummified/Skeletal

□ 3. Moderate Decomposition

LIVE ANIMAL INFORMATION

INITIAL LIVE ANIMAL DISPOSITION (Check one or more)

1. Left at Site	5. Died at Site
2. Immediate Release at Site	6. Died during Transport
3. Relocated and Released	7. Euthanized
4. Disentangled	8. Transferred to Rehabilitation:
□ a. Partially □ b. Completely	Date: Year: ______Month: _______Day:______ Facility:_______________________________
□ 9. Other:_________________________________________________________

CONDITION/DETERMINATION (Check one or more)

1. Sick 7. Location Hazardous
2. Injured □ a. To animal
3. Out of Habitat □ b. To public
4. Deemed Releasable □ 8. Unknown/CBD
5. Abandoned/Orphaned □ 9. No Rehabilitation Options
6. Inaccessible □ 10. Other: ____________________

DEAD ANIMAL INFORMATION

CARCASS STATUS (Check one or more)

□ 1. Frozen for Later Examination/Necropsy Pending

□ 2. Left at Site □ 5. Landfill □ 8. Towed: Lat__________Long___________

□ 3. Buried □ 6. Incinerated □ 9. Sunk: Lat__________Long___________

□ 4. Rendered □ 7. Composted □ 10. Unknown/Other______________________

NECROPSIED □ YES □ NO □ Limited □ Complete

Carcass Fresh □ Carcass Frozen/Thawed

CARCASS CODE AT NECROPSY □ Code 2 □ Code 3 □ Code 4

NECROPSIED BY:

Date: Year: Month: Day:

PHOTOS/VIDEOS TAKEN: □ YES □ NO

Photo/Video Disposition: ______

MORPHOLOGICAL INFORMATION

SEX (Check ONE) ESTIMATED AGE CLASS (Check ONE)

1. Male □ 1. Adult □ 4. Pup/Calf
2. Female □ 2. Subadult □ 5. Unknown
3. Unknown □ 3. Yearling

□ Whole Animal □ Partial Animal

Straight Length:______________ □ cm □ in

□ Actual □ Estimated □ Not Measured

Weight:___________________ □ kg □ lb

□ Actual □ Estimated □ Not Weighed

SAMPLES COLLECTED (Check one or more)

□ 1. Histology □ 2. Other Diagnostics □ 3. Life History

□ 4. Skeletal □ 4. Other ______________________________

PARTS TRACKING (Check one or more)

1. Scientific Collection □ 2. Educational Collection
3. Other:

_________________________________________________

OCCURRENCE DETAILS □ Restrand GE# _______________________

(NMFS Use)

Group Event: □ YES □ NO

If Yes, Type: □ Cow/Calf Pair □ Mass Stranding □ UME # Animals:________□ Actual □ Estimated

Was the Marine Mammal Human Interaction Report completed? □ YES □ NO

Findings of Human Interaction: □ YES □ NO □ Could Not Be Determined (CBD)

If YES evidence of: 1. Vessel Interaction □ YES □ NO □ CBD

2. Shot □ YES □ NO □ CBD

3. Fishery Interaction □ YES □ NO □ CBD

4. Other Human Interaction: ________________________________________

______________________________________________________________

If YES, what was the likelihood that the human interaction contributed to the stranding event?

□ Uncertain (CBD) □ Improbable □ Suspect □ Probable

Gear/HI Items Collected? □ YES □ NO Gear Disposition: ___________________________________

Other Findings Upon Level A: □ YES □ NO □ Could Not Be Determined (CBD)

If Yes, Choose one or more: □ 1. Illness □ 2. Injury □ 3. Pregnant □ 4.Other: ________________ How Determined (Check one or more): □ External Exam □ Internal Exam □ Necropsy

□ Other: ______________________________________________________________

Shape1 NOAA Form 89-864; OMB Control No.0648-0178; Expiration Date 03/31/2020

TAG DATA

Tags Were:

Present at Time of Stranding (Pre-existing): □ YES □ NO

Applied during Stranding Response/Release: □ YES □ NO

Applied during Rehabilitation/Release: □ YES □ NO

Absent but Suspect Prior Tag: □ YES □ NO

ID# Color Type Placement* Applied Present Removed

(Circle ONE)

D DF L R □ □ □ _________________________LF LR RF RR

D DF L R □ □ □ __________________LF LR RF RR

D DF L R □ □ □

__________________LF LR RF RR

* D= Dorsal; DF= Dorsal Fin; L= Left Lateral Body R= Right Lateral Body LF= Left Front; LR= Left Rear; RF= Right Front; RR= Right Rear

ADDITIONAL IDENTIFIER: _________________________________________________ (If animal is restranded, please indicate any previous field numbers here)

ADDITIONAL REMARKS: ____________________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________

DISCLAIMER

THESE DATA SHOULD NOT BE USED OUT OF CONTEXT OR WITHOUT VERIFICATION. THIS SHOULD BE STRICTLY ENFORCED WHEN REPORTING SIGNS OF HUMAN INTERACTION DATA.

DATA ACCESS FOR LEVEL A DATA

UPON WRITTEN REQUEST, CERTAIN FIELDS OF THE LEVEL A DATA SHEET WILL BE RELEASED TO THE REQUESTOR PROVIDED THAT THE REQUESTOR CREDIT THE STRANDING NETWORK AND THE NATIONAL MARINE FISHERIES SERVICE. THE NATIONAL MARINE FISHERIES SERVICE WILL NOTIFY THE CONTRIBUTING STRANDING NETWORK MEMBERS THAT THESE DATA HAVE BEEN REQUESTED AND THE INTENT OF USE. ALL OTHER DATA WILL BE RELEASED TO THE REQUESTOR PROVIDED THAT THE REQUESTOR OBTAIN PERMISSION FROM THE CONTRIBUTING STRANDING NETWORK AND THE NATIONAL MARINE FISHERIES SERVICE.

PAPERWORK REDUCTION ACT INFORMATION

Shape4 Shape3 Shape2

NOAA Form 89-864; OMB Control No.0648-0178; Expiration Date 03/31/2020

NOAA Form 89-864 (rev. 2007)

OMB No. ________; Expires _________

PUBLIC REPORTING BURDEN FOR THE COLLECTION OF INFORMATION IS ESTIMATED TO AVERAGE 30 MINUTES PER RESPONSE, INCLUDING THE TIME FOR REVIEWING INSTRUCTIONS, SEARCHING EXISTING DATA SOURCES, GATHERING AND MAINTAINING THE DATA NEEDED, AND COMPLETING AND REVIEWING THE COLLECTION OF INFORMATION. SEND COMMENTS REGARDING THIS BURDEN ESTIMATE OR ANY OTHER ASPECT OF THE COLLECTION INFORMATION, INCLUDING SUGGESTIONS FOR REDUCING THE BURDEN TO: CHIEF, MARINE MAMMAL AND SEA TURTLE CONSERVATION DIVISION, OFFICE OF PROTECTED RESOURCES, NOAA FISHERIES, 1315 EAST-WEST HIGHWAY, SILVER SPRING, MARYLAND 20910. NOT WITHSTANDING ANY OTHER PROVISION OF THE LAW, NO PERSON IS REQUIRED TO RESPOND, NOR SHALL ANY PERSON BE SUBJECTED TO A PENALTY FOR FAILURE TO COMPLY WITH, A COLLECTION OF INFORMATION SUBJECT TO THE REQUIREMENTS OF THE PAPERWORK REDUCTION ACT, UNLESS THE COLLECTION OF INFORMATION DISPLAYS A CURRENTLY VALID OFFICE OF MANAGEMENT AND BUDGET (OMB) CONTROL NUMBER.

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	Microsoft Word - Level A 2010-11
Author	Stephen.Manley
File Modified	0000-00-00
File Created	2021-01-22