ZOO/AQUARIUM GENERAL HEALTH and DIET HISTORY FORM: FISH TELEOSTS and ELASMOBRANCHS. Date: Facility name: Facility address: Contact name: Position:

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ZOO/AQUARIUM GENERAL HEALTH and DIET HISTORY FORM: FISH TELEOSTS and ELASMOBRANCHS Contact Information Date: Facility name: Facility address: Contact name: Position: Best contact information (phone

1 ZOO/AQUARIUM GENERAL HEALTH and DIET HISTORY FORM: FISH TELEOSTS and ELASMOBRANCHS Contact Information Date: Facility name: Facility address: Contact name: Position: Best contact information (phone number, ): Primary veterinarian name (if different from above): Veterinarian contact information (phone number, ): Animal Information * Note: If any of the following answers require more space to answer completely, please attach additional pages and just number the answers according to the corresponding question. Species: Number of animals housed together: 1) If applicable, please provide the following detailed information: ID Number House Name Sex Age Current Body Weight* Current Body Condition* *Current body weight in grams or kilograms. Current body condition on scale from 1 to 5, where 1 is emaciated, 3 is ideal, and 5 is obese. 1

2 2) If applicable, please provide the following information as to reproductive status. ID Number Chemical birth control Reproductively active 3) Tank type: Closed filtration tank system Open, flow-through system Combination system 4) Exhibit location: Indoor only Outdoor only Both If any part of the exhibit is located outside, is there shade provided? Yes, total Yes, partial None 5) Are any of the animals currently being treated for any condition(s) or disease(s)? Yes No If yes, please list animal ID, diagnosed condition/disease, approximate date of diagnosis, medications. Animal ID Condition/Disease Date Diagnosed Medication Name, Dose, Route, Freq., Length Example: Deep tissue wound 2/12/18 Erythromycin, 100mg IM, 1x/day, 7 days Example: All Parasites 2/12/18 Copper sulfate, 0.15 ml/l, 14 days 2

3 Diet and Enrichment Information 6) How are the fish fed? General broadcast feed Target/pole-fed Combination of both methods Instructions for the following questions: Be sure the Amount provided is measurable. Always weigh the measured amount of food on a gram scale and provide the total gram weight for each ingredient. Possible scenarios to troubleshoot: Unlabeled cup or scoop: First measure the amount held in that cup/scoop - for example, ½ scoop may actually represent a true 1 cup, as measured. Then weigh the volume of diet item held within that container. Abstract unit of measure (e.g. one handful ), take one handful of the item and obtain the gram weight of that handful 5 days in a row. If different individuals are doing the feeding, make sure that each individual s handful is represented. Then calculate the average weight (grams) per handful by summing the gram weights from each of the 5 days, and diving by 5. Provide that average weight as the Amount below. 7) Please describe all brands, product names, amounts and frequency for ALL commercial foods offered as a part of the regular diet. Manufacturer Product Name Form Amount Frequency Example: Ocean Nutrition Formula 2 Marine Pellet dry pellet 50g 2x/day 3

4 8) List all other food items offered as a part of regular diet (including broadcast and/or target/pole feeds). Specify leafy greens, vegetables, cut fish, invertebrates (clams, squid, crabs, etc.), etc. Provide information on how the food is prepared (whole vs. chopped, cooked vs. raw, live vs. frozen/thawed, etc.), food item gram weights and measured amounts, frequency offered per day, and days fed per week (see examples below). Food item Preparation Amount/Weight (grams) Freq per day Days per week Example: Smelt Whole, frozen/thawed 50g 2x/day Daily Example: Romaine Whole leaves 100g 2x/day M, W, F 9) List other food items offered for enrichment and/or medication purposes (e.g. training, interactive sessions, educational programs, etc.). Food item Preparation Amount/Weight (grams) Frequency Months offered Example: Crabs Whole 500g Once Oct, Nov, Dec 4

5 10) Are there any seasonal variations to the diet provided (aside from enrichment items offered)? If so, please thoroughly describe. 11) In the last 5 years, have you ever had a nutrient analysis performed by a laboratory on either the whole diet and/or any individual food items (e.g. hay, browse, leafy greens, etc.)? Yes No If yes, please provide copies of analyses. 12) Are there any food items the animals particularly prefer? Please describe. 13) Are there any food items the animals do not particularly like and/or refuse? Please describe. 14) Have you made any changes to the diet offered in the last 4 weeks?: Yes No If so, please describe the change made. 15) Are any dietary supplements (vitamins, fatty acids, oils, etc.) given? Yes No If yes, please describe brand/type, quantity, frequency. Manufacturer Type Dose Frequency Example: Mazuri Shark/Ray Vitamin 0.19mg 1 tablet 1x/day 5

VITAMIN SURVEY FORM CODE: VIT Version B

ARIC MRI VITAMIN SURVEY FORM CODE: VIT Version B ID Number: Contact Year: 16 Instructions: Whenever numerical responses are required, enter the number so that the last digit appears in the rightmost box.