AFB Reporting and Destruction Form

7 DAY notification to the Management Agency, of a case(s) of American Foulbrood Biosecurity (National American Foulbrood Pest Management Strategy) Order 1998

Beekeeper name*

Beekeeper registration number*

Company name

Address*

Contact phone number*

Email address*

Date found

Date destroyed

MAF apiary number

Number of hives found with AFB

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

Name of owner or occupier of property where apiary is situated

Property name (if applicable)

Address of property (street/road and number)

Latitude (eg. -42.991202)

Longitude (eg. 171.860421)

Level of Infection (based on the number of AFB infected larvae found)Light: Signs of AFB in one or two cells onlyModerate: Signs of AFB found in one or up to four brood frames.Heavy: Signs of AFB found in five or more brood frames.

Possible source of infection

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.