B08_Solicitation_Attachment_4_-_4710-15_Death_Report_(Rev_06_05_2024).pdf
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- Solicitation number
- 140L0125R0003
About this file
This is a Preparation Facility Death Report form template used as an attachment for a Bureau of Land Management (BLM) Wild Horse Burro Program Off-Range Corral Support Services solicitation. The form is designed to document deaths of horses, burros, or mules in BLM facilities.
The form captures key information including death date, FM number, manner of death (with four categories: euthanized acute/sudden, euthanized chronic, died acute/unexpected, or died chronic), and an extensive checklist of 42 possible causes of death ranging from anesthetic death to undiagnosed conditions. Additional fields include documentation for unmarked animals (herd area, species, sex, age) and requires a mandatory comment section. The form appears to be revision dated June 5, 2024, and serves as a standardized reporting template for tracking mortality events in the Wild Horse Burro Program's off-range facilities.
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Text version
Preparation Facility Death Report
Death Date: ____________________
FM Number: ___________________
Manner of Death: (check only one) ___ Euthanized: Acute or Sudden Condition ___ Euthanized: Chronic or Pre-existing Condition ___ Died: Acute or Unexpected Death ___ Died: Chronic or Following Long Illness
Cause of Death:
__ Anesthetic Death __ Blindness or Eye Abnormality __ Body Condition: Unable to Maintain or Improve __ Cancer or Tumors __ Club Foot __ Colic __ Cryptorchid __ Dangerous
__ EIA
__ Foaling Complications __ Fracture/Brain Injury: Head Acute/Sudden __ Fracture/Spinal Cord: Neck or Back Acute/Sudden __ Fracture: Chronic/Pre-Existing __ Fracture: Leg or Pelvis Acute/Sudden __ Gelding Complication: Evisceration __ Gelding Complication: Hemorrhage __ Gelding Complication: Other __ Heart Disease or Failure __ Hoof: Abscess or Slough or Injury __ Injury: Soft Tissue __ Kidney Disease or Failure
Signed: ______________________________
IF animal is Unmarked Herd area: _____________________ ___ Species: H-Horse, B-Burro, M-Mule ___ Sex: F-Female, M-Male ___ Age
__ Laceration __ Lameness __ Lipemia/Hyperlipidemia __ Liver Disease/Failure __ Neurological __ No Teeth or Dental Abnormality __ Old Age __ Other __ Physical Defect or Deformity: Acquired __ Physical Defect or Deformity: Congenital or Developmental __ Respiratory: Other __ Respiratory: Pneumonia __ Starvation (food or water) __ Strangles – Internal abscesses __ Strangles – Purpura Hemorhagica __ Strangles – Respiratory __ Toxicity (food or water) __ Undiagnosed/Unknown __ Undiagnosed/Unknown: Found dead on pasture
Comment (Required): _______________________
File details come from the government source that posted it. Updated .