First Name	Last Name
Organisation/Business Name	Email
Which best describes your role on the dairy farm

Mobile Phone number

Please enter your mobile number without spaces

Number of copies

Postal address

Street	Town/City
State	Postcode

The information provided will be used in accordance with our privacy policy

Please answer a few quick questions about milking practice on your farm

Do you wear gloves when milking

AlwaysSometimesNever

Do you wash cow's teats prior to milking

NeverOnly if the udder is very dirtyIn high risk periods (wet weather, muddy conditions, early lactation)Always

When washing teats do you dry them with disposable towels/cloths

AlwaysSometimesNever

Do you apply post milking teat disinfection

AlwaysSometimesNever

Is your teat disinfection product purchased as

Ready-to-useConcentrate to dilute on farmDon’t know

When giving an intramammary dry cow or lactating cow treatment do you use alcohol swaps to disinfect the teat end

AlwaysSometimesNeverDon’t treat cows

Have you completed a "Cups On Cups Off" course

NoYes, over 2 years agoYes, within the last 2 years

If you know your Dairy Enterprise number and/or your Farm PIC number please enter them below

Dairy Enterprise Number

Farm PIC number

Dairy Industry Involvement

If you are not on farm could you describe your involvement in the dairy industry?

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