Animal Element Occurrence Field Form For a list of elements tracked by CNHP, refer to Element Tracking List Please submit at least one of Common Name or Scientific Name. Fields marked with an asterisk (*) are required. Element Common Name(s): Element Scientific Name: Observer Name*: Observer Affiliation: Observer Phone: Observer Email*: Observer Address: City: State/Zip: ALASKA ALABAMA ARKANSAS ARIZONA CALIFORNIA COLORADO CONNECTICUT DELAWARE FLORIDA GEORGIA HAWAII IOWA IDAHO ILLINOIS INDIANA KANSAS KENTUCKY LOUISIANA MASSACHUSETTS MARYLAND MAINE MICHIGAN MINNESOTA MISSOURI MISSISSIPPI MONTANA NORTH CAROLINA NORTH DAKOTA NEBRASKA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEVADA NEW YORK OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VIRGINIA VERMONT WASHINGTON WISCONSIN WEST VIRGINIA WYOMING Survey Date*: Location Information (Required) Please submit a ZIP file of a scan of a map with the observation marked/outlined, or an attributed GIS file, or detailed driving/hiking directions, or attributed list of coordinates. (Please submit at minimum, either a full Legal Description, or Driving/Hiking Directions.) USGS Quadrangle: Surveysite Name: (from 7.5' quad) County: Adams Alamosa Arapahoe Archuleta Baca Bent Boulder Broomfield Chaffee Cheyenne Clear Creek Conejos Costilla Crowley Custer Delta Denver Dolores Douglas Eagle Elbert El Paso Fremont Garfield Gilpin Grand Gunnison Hinsdale Huerfano Jackson Jefferson Kiowa Kit Carson Lake La Plata Larimer Las Animas Lincoln Logan Mesa Mineral Moffat Montezuma Montrose Morgan Otero Ouray Park Phillips Pitkin Prowers Pueblo Rio Blanco Rio Grande Routt Saguache San Juan San Miguel Sedgwick Summit Teller Washington Weld Yuma Quadcode: (If known.) Min Elev: Meters Feet Max Elev: Legal Description: Township: Range: Section: ¼ Sec: UTM Coordinates: Northing: Easting: UTM Zone: 12 13 Datum: NAD27 NAD83 WGS84 Other Datum Other: GPS Accuracy: Meters Feet GPS Correction: Autonomous(uncorrected) Differentially Corrected Other GPS Other: Driving/Hiking Directions Additional Coordinates: Back to top Northing: Easting: Data: Northing: Easting: Data: Northing: Easting: Data: UTM Zone: 12 13 Datum: NAD27 NAD83 WGS84 Other Datum Other: Observation Details (Required) Back to top Size (Area of occupancy, population abundance, density) Number of Individuals Age(s)/Sex(es)(if known): Comments: Condition (productivity, vigor of individuals) Reproductive Evidence: Evidence of Disease, Predation or Injury: Comments: Landscape Context Comments (structure, condition and extent of surrounding landscape; abiotic physical/chemical factors) General Habitat Description Back to top Dominant Plant Community: Associated Animal Taxa: General Habitat Comments: Ownership Back to top Private USFS BLM State Military Indian BuRec NPS Other Other: Owner Name: (or National Forest, BLM District, etc.) Owner Comments: (special requests, permissions, circumstances) Protection Comments Back to top (Comments on any legal protection or strategies proposed or in place) Management Comments Back to top Evidence of Threats and Disturbance: (e.g., effects on population viability due to mining, recreation, grazing, exotic species etc,; past/present/future recomendations) Predominant Land Uses: Exotic Species: Documentation Back to top Photographs Taken: Yes No Photographer: Photo Number(s): Repository: Specimens Taken: Yes No Collector: Collection Number(s): Repository: Extra field (Leave Blank): General Comments Back to top Please confirm the data entered before clicking submit.