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Hemlock Woolly Adelgid Observation Form

Personal Data

All information will be kept secure and only viewable by the researchers.

Name:

E-Mail:

Phone:

Address:

Please fill out as many fields as possible so that we may contact you if neccesary. State as a 2 letter acronym.

Street Address:

City:

State:

Zip-Code:

Sighting Information

Date

Location

Please fill out as many fields as possible to help specify the location. State as a 2 letter acronym.

GPS:

Street Address:

County:

City:

State:

Zip-Code:

Property Owner Information

Property Owner:

Address:

Please fill out as many fields as possible to help specify the location. State as a 2 letter acronym.

Street Address:

City:

State:

Zip-Code:

Please provide an estimate of how many trees were infected and the severity.

# of Trees Infected:

Severity:

Field Notes: