AFB reporting and destruction form

Beekeeper name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Date found

MM

DD

YYYY

Date destroyed

MM

DD

YYYY

Was the hive(s) a "robbed out" hive

Yes

No

Name of owner or occupier of property where apiary is situated

First Name

Last Name

Address of property (include the property name if applicable)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Level of Infection (based on the number of AFB infected larvae found)

Light: Signs of AFB in one or two cells only

Moderate: Signs of AFB found in one or up to four brood frames.

Heavy: Signs of AFB found in five or more brood frames.

Beekeeper’s statement - AFB destruction *

I certify that an American Foulbrood case(s) was discovered in a beehive(s) as listed above, and that these honey bees and the associated bee products and equipment will be destroyed within 7 days of my becoming aware of the case(s), or dealt with in accordance with my DECA. By pressing submit, I am agreeing to the statement above.

I agree