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Livestock Producer Disaster Coordination and Contact Information Form

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					Livestock Producer Disaster Co-ordination & Contact Information Form

This form is designed for the livestock producer to provide accurate information to the Agency or Agencies
(usually your local municipal government or regional district, but may be PEP, MOFR, and/or RCMP or any
other agency depending on the nature and location of the emergency) providing assistance with livestock
during a natural disaster, such as a Forest Fire, Flood, Earthquake or other disasters that may result in
the need to evacuate livestock from a particular area.
The livestock producer should keep on file a duplicate copy of this form when sending it to the Agency
responsible for disaster response for verification purposes.

Section A: (to be filled out by the Agency receiving this information prior to an emergency, so that any
other organization that this information is shared with in the case of an emergency knows who within this
agency is the contact for a particular livestock producer)
Name of Agency/Ministry/Organization:________________________________________________
Address of Agency:_____________________________________________________________________
City:_____________________________ Province:___________________ Postal Code:____________
Name of Representative:________________________________________________________________
Phone:_________________________ Cell:_________________________ Fax:_____________________
Email address:_________________________________________________________________________
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Please check type of disaster: ____ Forest Fire, ____ Flood, ____ Earthquake, ____ Other
(if other please specify)_________________________________________________________________________________



Section B: (to be filled out by the livestock producer)

Farm/Ranch Name:____________________________________________________________________
Owner Name(s):________________________________________________________________________
Mailing Address:_______________________________________________________________________
City:_______________________ Province:_______________________ Postal Code:_______________
Phone (home) #:_____________________________ Phone (bus) #:______________________________
Cell #:_______________________________ Fax:_____________________________________________
Email address:_________________________________________________________________________

Physical address/location of farm/ranch: (note: the more accurate information the better - for
example use co-ordinates, lot #’s, Road & highway names, kilometre marks etc. as this can greatly assist
air and ground crews during an emergency. A map of your property should be attached.
Lot # of Property:_______________________________________________________________________
Co-ordinates of Property if known: (Longitude/Latitude) ____________________________________
Highway/Road Name:__________________________________________________________________
Kilometre Mark:________________________________________________________________________
Additional Location Information:_______________________________________________________
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01/01/2010                                                                                      Page 1
Section C: Range Tenure information (to be filled out by the livestock producer) This information
should be accompanied by a map of your range area.

MOFR District:_________________________________________________________________________
Name of the range Agrologist for your area:_____________________________________________
Phone #:_____________________________ Cell #____________________________________________
Fax #________________________________ Email address:___________________________________


Section D: Identification of possible evacuation sites on your property, on your range, or
at another location. (This information should be referenced to the maps of your property and range
unit that you provide with this form and identified using co-ordinates and pasture names, road/highway
names, kilometre marks, and/or geographic features - such as a lake, creek, logging block or landing. Also
state type of terrain that may impact how livestock are managed and/or moved during an evacuation. For
example if your range is flat, steep, swampland, heavily timbered etc. List typical length of time to round
up livestock: (1 day, 2 days etc.) Use an additional sheet if needed.
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01/01/2010                                                                                      Page 2
Section E: Additional information: such as # of additional wranglers that may be needed and any
skills they may need (such as knowledge of cattle, horses etc.) Anything that may assist or expedite the
round-up of livestock such as helicopter over flight to determine how many animals, where, and how widely
dispersed they are in remote locations. In addition, a list of livestock haulers and their contact
information in your area if you are not hauling your livestock yourself, or if you need additional haulers to
help evacuate livestock more quickly.
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01/01/2010                                                                                       Page 3
Section F: Information regarding type and class of livestock that may be in need of
evacuation or feeding in case of an emergency. (to be filled out by livestock producer.)

Type and class of livestock (check all that apply):
____ Cattle: ____ cows, ____ calves, ____ bulls, ____ yearling heifers, ____ yearling steers

____ Horses: ____ mares, ____ foals, ____ stallions, ____ geldings

_____ Sheep: ____ ewes, ____ lambs, ____ rams

Other livestock: ____ pigs, ____ poultry, ____ goats, ____ dogs, ____ cats, ____ other (if
other please specify). ___________________________________________________________________________________

Note: the number of livestock on a farm/ranch can change from year to year and season to season. To
more accurately reflect the numbers of animals that may need feed/care/or evacuation from a particular
area, it is more useful to give these numbers to the agency at the time assistance is required. The agency
receiving this information can then write in the number of livestock on this form. However an estimated
herd size can be given ahead of time and can give responders a better idea of what is entailed.

Estimated herd size: (e.g. 100 - 200 animals) __________________

# of cows______, # of calves ______, # of bulls _______, # of heifers______, # of steers______
Total # of cattle _______________

# of mares______, # of foals_______, # of stallions______, # of geldings______
Total # of horses______

# of ewes______, # of lambs______, # of rams______,
Total # of sheep________

Other livestock: (specify class of livestock)

Pigs___________________________________________________________________________________
Poultry________________________________________________________________________________
Goats__________________________________________________________________________________
Dogs___________________________________________________________________________________
Cats___________________________________________________________________________________
Other__________________________________________________________________________________


Section G: (to be filled out by livestock producer)

This information was sent to (Agency):_________________________________________________
Date:___________________________________ Signature:___________________________________
*Remember to attach maps of your property and/or range area.*

01/01/2010                                                                                       Page 4

				
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