CT Department of Environmental Protection
Natural Diversity Database
COA Avian Survey Form
This form is to be used to report a personal field sighting of an Endangered, Threatened, or Special
Concern bird species tracked by the CT Natural Diversity Database. This form must be accompanied by
a USGS topographic map of the site. Include a photograph suitable for bird identification, if possible.
Species Name :
Dates of Observation:
(Include multiple dates
in one year)
Name of Observer(s):
Address:
Telephone:
Affiliation:
Fax:
E-mail Address:
Connecticut Ornithological Association
Location Information: Please attach a copy of a 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:
USGS Quad Name:
(optional)
Locality Name:
Size of area occupied for nesting or feeding
during breeding season:
Historical presence of this species at this site:
Directions to site: Include parking options and best site access points.
Detailed Site Sketch
GPS Coordinates (Optional)
Datum: NAD83 or WGS84
Latitude:
N
Longitude:
GPS Model:
Standard Error
of Measurement:
Real Time
Corrected:
W
Yes
No
Population Information:
Number of Individuals Observed/Estimated:
Nature of Observation:
Sight
Capture*/Release
Song/Call
Photograph Taken
Specimen collected+
Road Kill/Dead
Repository:
Other (specify):
*Method of Capture (net, pit-fall trap, hand collected, dip net/seine, trap, etc.):
+DEP Scientific Collection Permits are required for collecting specimens
Biology/Behavior:
Evidence of Reproduction:
Feeding:
Other Behavior (flying,
resting/basking, etc.):
Highest Level of Breeding (Enter one code from instruction sheet) Date:
Multiple site visits can provide additional information to improve the level of breeding evidence.
Observed:
Possible:
Probable:
Confirmed:
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:
Property Ownership: If known, please provide landowner name, address, and phone number, and if
permission is required to access the site.
Please send the completed form and map to:
Buzz Devine, 18 South Street, Plymouth, CT 06782
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