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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