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This form is designed to collect information from the public regarding sick and dead birds. The main purpose of this survey is to assist us in our surveillance efforts for avian influenza, and therefore our primary interest is in waterfowl, shorebirds, and raptor species.
Please fill in all information to the best of your ability. We will contact you for additional information if needed, so please include complete contact information.
1.
Please enter the date that you found the bird(s):
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2.
PLEASE ENTER YOUR CONTACT INFORMATION HERE:
Name, First and Last
Street Address City, State Zip
Phone number
3.
Sick or Dead Bird Information
Please gather any information from visual observations only. Do not attempt to handle sick or dead birds.
Was the bird(s) you found dead or alive?
Dead
Alive
Mixed: Some were dead and others were alive
Please contact
lchase@azgfd.gov
if you have any questions regarding this survey.
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