Emerald Ash Borer Reporting Form

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Contact Information

First Name *

Last Name *

Phone Number

Email *

Location of Sighting

Street Address *

(If there is no street address, describe as best you can the location [a park, a business name, etc.]. Please use any landmarks you observed at the site to help indicate the exact location. Note street intersection if appropriate.)

City/Town *

Zip Code

Sighting Details

Describe the insect seen, if one was observed

(Color, size, shape, etc.)

Describe any ash tree damage seen, if any [NOTE: Emerald ash borer only attacks ash trees, genus Fraxinus, or fringe trees, genus Chionanthus.]

(Holes in tree [indicate size and shape], S-shaped tunnels in bark, dieback of upper canopy of tree, etc.)

Additional Questions

How did you hear about the emerald ash borer? *

News coverage on tv, radio, or in a newspaper

An internet news source

Word of mouth

A presentation or training class

A billboard or poster

A public meeting (town meeting, etc.)

A mailing or a flyer left at a residence

Utility bill

A display at an event, public library, etc.

Other:

Anything Else?

(If you have any other questions or issues not addressed in this form, let us know here)

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