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Date of manure emissions
Health Comments - Describe what you experienced in your own words: symptoms, physical or mental/emotional? did you change your daily routine? see a doctor, take medication? other?
Location of Emissions - address or nearest road intersection, township if you know it
County
Manure Source - name of farm or livestock operation if you know it
Length of Exposure - hrs, days, weeks?
Health Distress Ranking (1-4)
These and other symptoms have been reported by people living near large livestock operations - they are a guide only. You may have some or none of these symptoms, or others. Choose the number closest to your health distress.
1 Unpleasant - 4 Intolerable
1 - Manure odor is noticeable: unpleasant to work outside 2 - Physical or mental/emotional symptoms: eye or throat irritation, breathing, wheezing, headache, nausea, anger, daily activities change 3 - Symptoms worsen: migraines, laryngitis, diarrhea, depression, crying, windows closed even in hot weather, visitors leave the house 4 - Intolerable physical or mental distress: vomiting, severe headaches, asthma attack, rage, confusion, call or go to a doctor, need medication
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