Habitat Data: Describe the general area where the occurrence is located. List community types, dominant 

 vegetation, and information on the physical environment such as substrate type, hydrology, moisture regime, slope, 

 elevation, and aspect. Also, if possible, provide information on the surrounding land use and extent of additional 

 suitable habitat. f 



Weather Conditions: 



□ clear □ overcast □ calm □ windy 



Describe temperature, precipitation, and other significant weather factors: 



Conservation: Are there any natural or human threats to this occurrence? Please describe. 



Ownership: If known, please provide landowner name, address and telephone number. 



Information Source: 



"Name, Address, and Telephone Number (of person filing report) 



K *Does this information come from □ a field visit, □ a 2nd party observation, or □ a published or unpublished report? 



Citation: For information taken from a published or unpublished report, please provide a copy of the cover page and 

 pertinent portions of the report. If a copy cannot be provided, list below the author, date, title, publisher, and page 

 numbers. 



Voucher: Was the observation vouchered with □ a photograph? □ a specimen? 



If possible, attach a copy of the photograph. If specimen voucher, please provide the collection # and name of the 



repository: 



Identification: How was the species identification made? Was it based on a sighting, track, call, scat, road kill, etc.? 

 Name the identification manual(s) used or expert(s) consulted. Were there identification problems? 



Confirmation: Would you accompany a biologist to the site if needed? □ yes □ no 

 Additional Comments: (use additional sheets if needed) 



Required Field 



