Avian Fatality/Injury Report - Indiana Electric Cooperatives

YOUR NAME *

COOPERATIVE *

YOUR EMAIL *

YOUR PHONE *

SUPERVISOR IN-CHARGE NAME *

SUPERVISOR IN-CHARGE EMAIL *

SUPERVISOR IN-CHARGE PHONE *

DATE DISCOVERED *

TIME COLLECTED *

CONDITION OF BIRD *

Alive

Injured

Dead

If bird is injured, contact Marty Jones: 317.696.6246.

IS THE BIRD AN EAGLE? *

Yes

No

If yes, immediately contact Marty Jones, 317.696.6246, and/or conservation officer.

BIRD SPECIES *

If unknown, contact Marty Jones: 317.696.6246.

PLEASE UPLOAD PHOTO(S) OF THE BIRD.

Maximum file size: 209.72MB

Photos are important should the identity of a bird species be questioned at a later date.

POLE NUMBER *

LATITUDE *

LONGITUDE *

SURROUNDING HABITAT *

SUSPECTED CAUSE *

DISPOSITION OF BIRD *

WHAT EQUIPMENT MODIFICATIONS HAVE YOU MADE?

Following the discovery of a dead bird, the utility must investigate possible modifications that can be made to make the location avian safe.

EQUIPMENT *

ADDITIONAL NOTES