Report for Migratory Bird Damage or Danger Permit

To be completed by the permit holder

Permit holder (full name):
Permit number:
Date of report:
Name of business/organization (if applicable):
Telephone Number:
Email Address:
Fax:

Note: For any given permitted activity and for each location of activity, reporting must be completed as per the requirements described on the permit. A report is required even if you did not conduct any activity (i.e. if the applicant was authorized to destroy a nest under which no nests were destroyed,the applicant must still submit the report with a value of zero (ex. Nests destroyed: 0)). Attach extra sheets if the space provided is not sufficient.

Attestation:

I, (print full name), hereby attest that I have reviewed all of the requirements as indicated on my permit and confirm that this completed report fulfills all reporting requirements.

Signature of Permit Holder

Date (yyyy/mm/dd):

Date of Receipt (yyyy/mm/dd):

If all activities were conducted in one location, please proceed to the appropriate report log for the permitted activities. If activities were conducted in several locations, please list all locations in the table below and fill out the “Location Code” column for the permitted activities. If the activities are numbered on the permit, please order the locations in the sequence corresponding to the activity locations order listed on the permit

List the Location(s) of where the activity(ies) took place

Code:
Location Information:

Kill-to-support scaring

Were all activities conducted at one location?

[Checkbox] Yes
[Checkbox] No            

If yes, include location details in the row below. If no, ensure that all locations are included in the numbered list on page 2 of this report and fill out the “Location Code” column below accordingly.

Location:

Authorized maximum number allowed on permit of birds killed per week OR
Authorized maximum number allowed on permit of birds killed per year OR
Authorized maximum number allowed on permit of birds killed for duration of permit.

Authorization period:

from:
to:

Location Code:
Date of activity: (yyyy/mm/dd) Please fill one row for each date the activity occurred
Species:
Number of adult birds killed:
Number of immature birds killed:
Method used (if a firearm was used, must indicate the type of firearm):
Subtotal:

Report any birds that have been banded directly to the Bird Banding Office at reportband.gov, which will prompt you to provide the necessary details.

Kill-to-remove

Were all activities conducted at one location?
[Checkbox] Yes
[Checkbox] No            

If yes, include location details in the row below. If no, ensure that all locations are included in the numbered list on page 2 of this report and fill out the “Location Number” column below accordingly.

Location:                     

Authorized maximum number allowed on permit of birds killed per week OR
Authorized maximum number allowed on permit of birds killed per year OR
Authorized maximum number allowed on permit of birds killed for duration of permit.

Authorization period:
from:
to:

Location Code:
Date of activity: (yyyy/mm/dd) Please fill one row for each date the activity occured
Species:
Number of adult birds killed:
Number of immature birds killed:
Method used (if a firearm was used, must indicate the type of firearm):
Subtotal:

Report any birds that have been banded directly to the Bird Banding Office at reportband.gov. Please provide marker numbers found, such as leg bands, neck collars on any of the birds killed (if applicable). Please state the source (e.g. leg band).

Collection, removal, destruction and disposal of eggs

Were all activities conducted at one location?
[Checkbox] Yes
[Checkbox] No            

If yes, include location details in the row below. If no, ensure that all locations are included in the numbered list on page 2 of this report and fill out the “Location Number” column below accordingly.

Location:                     

Authorized maximum number allowed on permit of birds killed per week OR
Authorized maximum number allowed on permit of birds killed per year OR
Authorized maximum number allowed on permit of birds killed for duration of permit.

Authorization period:
from:
to:

Location Code:
Date of activity: (yyyy/mm/dd) Please fill one row for each date the activity occured
Species:
Number of adult birds killed:
Number of immature birds killed:
Method used (if a firearm was used, must indicate the type of firearm):
Subtotal:

Report any birds that have been banded directly to the Bird Banding Office at reportband.gov. Please provide marker numbers found, such as leg bands, neck collars on any of the birds killed (if applicable). Please state the source (e.g. leg band).

Relocation of migratory birds, eggs and nests

Were all activities conducted at one location?
[Checkbox] Yes
[Checkbox] No

If yes, include location details in the row below. If no, ensure that all locations are included in the numbered list on page 2 of this report and fill out the “Location Number” column below accordingly.

Location:
Location code:
Date of activity: (yyyy/mm/dd) Please fill one row for each date the activity occured
Species:
Number of adult birds relocated:
Number of immaturebirds relocated:
Number of nests relocated:
Number of eggs relocated:                  
Subtotal:

During the relocation activity, were there any mortalities or injuries? 
[Checkbox] Yes
[Checkbox] No            

If yes, how many adults died as a direct result of the activity(ies) authorized by your permit?
Injured?

If yes, how many immature died as a direct result of the activity(ies) authorized by your permit?
Injured?

What was the cause of the death(s) and/or injury(ies)?

Were the birds, nests or eggs taken to a rehabilitation center?
[Checkbox] Yes
[Checkbox] No
If yes, provide the rehabilitation center name:                     

Success of relocation activity

If a nest was relocated, did the adults find the relocated nests? Did the eggs/nestlings survive?

Please provide a description of your experience using this relocation technique, including the challenges faced and suggestions for improvement of the relocation technique. Please include photographs where appropriate.

Report any birds that have been banded directly to the Bird Banding Office at reportband.gov. Please provide marker numbers found, such as leg bands, neck collars on any of the birds killed (if applicable). Please state the source (e.g. leg band).