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

 vegetation, and information on the phv-sical en\-ironment such as substrate t\-pe, hydrology, moisture regime, slope, 

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

 suitable habitat. 



Weather C-onditions: 



□ clear □ overcast □ calm □ windy 



Describe temperature, precipitation, and other significant weather factors: 



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



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



Information Source: 

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



••Does this information come from Q a field visit, □ a 2nd party observation, or n a published or unpubUshed 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Citation: For information taken from a published or unpublished report, please provide a copy of the cover page and 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. 



Vouchen 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 



