AD Screening Form: Dairy Facility

Caution!

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The Following Errors must be resolved to submit this form:

1. Farm Location and General Information

* Farm Name: * Contact Person

Company Name
(if applicable):

Phone No.: * Email:

Farm Address:

* State:

* County:

2. Livestock Population

If the farm is divided into different sites, please use a different screening form for each site.

Milking Herd	* Average Number	Milk production, lb per cow-day
Lactating
Dry

Replacement Herd	* Average Number	Average weight, lb
Calves
Replacement heifers

3. Method of Confinement and Manure Storage

Please indicate hours per day in each type of confinement facility.

	Milking center	Flushed barn	Scraped barn	Flushed outdoor lot	Scraped outdoor lot	Pasture
* Lactating cows
* Dry cows
* Calves
* Heifers

* Do you separate manure solids? No Yes If so, how?

* How do you store manure and how often do you remove it?

Anaerobic lagoon with secondary storage
Storage tank or pond
Combined storage and treatment lagoon
Deep pit

4. Energy

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