Date :
Data taken by :
Farm Name :
Name of owner :
Name of Responsible for Health :
Type of production :
Race :
Périod (Season)
Date of Visit
Number de Heads
Number in lactation
Number of heifers
Number of calves
Average age of cows
Average yearly Production
Butterfat TB
Protein TP
Body State
Calving Interval
Holdind Average Insemination
Last Cell Count
Mastitis, Type, Number Last Year
Affected Quarter : left-f, lback, r-forward, right-b
Milk Fever in One Year
Placentary Rétention in One Year
Number of Staph Cows
Vaccines Given and When
Leg Problems
Footrot ? Ulcer of Sole? – Limping? Other?
Number for One Year?
Rennet Twist
Calves Problems? Scours Arthritis Parasites Others
Drying up : Homeo ? – Antibio ? Other way?
Parasites? Cows ? Heifers ? calves ? Intern ? Extern ?
Problems of Fertility
Metritis ? Kystes ? abortion ? Other
Toxins in Feed ?
Electric Stray Tensions? In the Past? Problem Solved? How? (Hesitation at Milking, Nervousness.
Your Expectations for the Betterment of the Herd :