STATE OF CONNECTICUT
| |Connecticut Dept. of Energy &Environmental Protection |
|[pic] |Natural Diversity Database |
| |Invertebrate Species Reporting Form |
|This form is to be used to report a personal field sighting of an Endangered, Threatened, or Special Concern invertebrate species tracked by the CT |
|Natural Diversity Database (deep/endangeredspecies). Please provide a USGS topographic map of the site and a photograph of the animal, if |
|possible, with this form. Only verifiable reports will be added to the database. |
| | | | | |
|Species Name : | |
|Date of Observation |(month/day/year): | |Time of Observation: | |
|Name of Observer (s): | |
|Affiliation: | |
|Address: | |
|Telephone: | |E-mail Address: | |
| | | | | |
|Location Information: Please attach a photocopy of the appropriate topographic map showing the precise area where the species was observed and draw a|
|detailed sketch of the site in the space provided below. The purpose of the sketch is to show fine details of the site not shown on the topographical|
|map. Attach an additional sheet of paper if necessary. |
| | | | | |
|Town: | | | |
|Locality Name: | |Approx. Acres of Potential | |
| | |Habitat: | |
|Is the full extent of the population known? | |Explain: | |
| | | | |
|Directions to Site: Include parking options and best site access points. |
| |
|Coordinates (Optional) |WGS84, Decimal Degrees | | | |
|Lat: N | |Long: W | | | | |
|Source of Coords (GPS or other | |
|map source): | |
|Estimated Accuracy: | |
| | | | | |
|Property Ownership: If known, please provide landowner name, address, and phone number. |
| |
Detailed Site Sketch:
|Population Information: | | | |
| |Number of Individuals Observed/Estimated: |
| |Adults (include sex if known) | |
| |Immature (nymph, larva, pupa) | |
| |Cast skin or exuviae | |
| | | |
|Nature of Observation: | | | |
| | Sight | Capture*/ Discarded | Dead |
| | Specimen Collected+ |Repository: | |
| | Photograph Taken | Other (Specify) | |
|*Method of Capture (net, pit-fall trap, malaise trap, mv/uv light, bait, etc.): | |
|+DEEP Scientific Collection Permit is needed for capture, marking, salvage, release or disturbance of animals. |
| | | | |
|Biology/Behavior: | | |
| |Evidence of Reproduction: | |
| |Ovipositing on: | |
| |Feeding on: | |
| |Nectaring on: | |
| |Other Behavior | |
| | | | |
|Habitat/Site Description: (topography, plant communities, associated species, current land use) |
| |
|Disturbance and Threats: (describe any potential threats to the population or habitat) |
| |
|Conservation/Management Needs: |
| |
| |
Please send the completed form with map and photographs to: CT Department of Energy & Environmental Protection, Natural Diversity Database-Wildlife Division, 79 Elm Street, 6th Floor, Hartford, CT 06106 or email to deep.nddbrequest@
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