Endangered Resources

Forms

Form 1700-048 (R 9/02)

NHI Rare Animal Field Report Form

Notice: Completion of this form is voluntary. Data collected will be used to supplement the Wisconsin Natural Heritage Inventory database. Personal information collected on this form will be used to process your request, and is intended to be used to contact you if DNR staff require additional information; it may also be made available to requesters under Wisconsin’s Open Records law [ss. 19.31-19.39, Wis. Stats].

NOTE: An email address is required in order to submit a report using the online form. If you do not have an email address, please contact Rich Staffen for a hard copy of the form or other electronic options.

Observation Information
Scientific name:
Common name:
Observation date:
Time:
Weather conditions:

Nature of observation:

Sight Record
Road-kill
Tracks
Song
Collected specimen
Deposit Location:
Other
Please explain:    

Location
County: 7.5 Minute quadrangle name:
Township: N Range (E/W): Section: 1/4 1/4:

GPS Coordinates: GPS Position accuracy: meters GPS Datum: GPS'd Date:
Directions to site: *

* Also email a map of the site (USGS 1:24,000 Topographic Map preferred) and mark the location of the rare species and its boundary (if known).

Landowner name (if known):

Note: The Natural Heritage Program can not accept data derived from trespass. Please gain landowner’s permission before entering private property.

Observation Details
Numbers observed - Give age and sex if known:
Evidence of reproduction at site:
Behavioral notes:
Associated Natural Community or Plant Community:
Describe Habitat - Include associated plant species:
Associated animal species - Especially related taxa:
Evidence of disturbance or threats to the population or site:
Was a photograph taken?

Yes No

Please email us any photos you may have taken of your observation.

Observer Information
Name:
Email:
Address:
City:
State:
Zip Code:
Telephone Number:

Problems using this form? Please email Dawn Hinebaugh.

Last Revised: August 8, 2008