Get California Gypsy Moth Checklist Form

Get California Gypsy Moth Checklist Form

The California Gypsy Moth Checklist form is a crucial document designed to help individuals moving from gypsy moth quarantine areas to non-quarantine areas. This form ensures that outdoor household items are thoroughly inspected for gypsy moths, a pest that can harm over 300 types of trees and shrubs. By completing this checklist, you not only comply with the law but also contribute to the protection of your new neighborhood.

Ready to get started? Fill out the form by clicking the button below!

Structure

When planning a move from a gypsy moth quarantine area to a non-quarantine area in California, it is essential to be aware of the legal requirements surrounding the gypsy moth checklist form. This form is designed to ensure that individuals inspect their outdoor household items for any signs of the gypsy moth, a pest that can harm over 300 types of trees and shrubs. Before moving, residents must remove all life stages of this destructive insect to protect their new neighborhood. The checklist provides clear instructions for self-inspection, detailing what items to examine, such as patio furniture, lawn equipment, and recreational vehicles. It also emphasizes the importance of completing the inspection on moving day, if possible, and offers guidance on how to dispose of any egg masses found. If individuals prefer, they can hire a certified applicator to conduct the inspection. Keeping a copy of the completed checklist during the move is crucial, as it serves as official documentation that may be requested by USDA or state officials. For those needing assistance, resources are available online and through local agricultural offices to help navigate the inspection process.

California Gypsy Moth Checklist Preview

 

 

 

OK F

 

 

 

 

 

LO

OR

 

 

 

 

O

 

 

 

 

 

T

T

 

 

 

 

 

 

 

 

 

 

 

 

 

A

 

 

 

 

 

 

 

H

 

 

 

 

 

 

S

W

 

 

 

 

 

 

E

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

S

 

 

 

 

 

 

 

A

 

G

 

 

 

G

M

 

Y

 

 

G

 

 

 

P

E

 

 

 

 

 

SY MOTH

 

 

 

IT’S THE LAW: BEFORE MOVING, CHECK FOR THE GYPSY MOTH

What Does the Law Require?

If you are moving from a gypsy moth quarantine area to a non-quarantine area, you must inspect your outdoor house- hold items for the gypsy moth and remove all life stages of this destructive insect before you move. You may face penalties if you are required to inspect but fail to do so. Fortunately, this inspection is easy to do, and you will protect your new neighborhood from a voracious leaf eater that can attack over 300 kinds of trees and shrubs.

How Do I Know if I Live in a Gypsy Moth

Quarantine Area?

Visit www.YourMoveGypsyMothFree.com and click on the U.S. map to find out if you live in a quarantine area. If you do, you will need to inspect your household goods for gypsy moth if you’re moving to a non-quarantine area. If you do not live in a quarantine area, this law does not apply to you.

I Live in a Quarantine Area and Am Moving to a Non-Quarantine Area. How Do I Meet This Legal Requirement?

1)Use the self-inspection checklist on the back of this flyer r hire a qualified certified applicator to inspect your outdoor

household articles. If you are moving between April and August, you should complete the inspection on moving

day, if possible. If you cannot complete the inspection on moving day, you must protect the items from the possibility of infestation by sealing them under a tarp, keeping them indoors, or in a closed moving truck.

For self-inspection, follow these steps:

Carefully inspect all surfaces and crevices of your outdoor household articles such as patio furniture, lawn equipment, toys, grills, trailers, and vehicles for gypsy moth egg masses.

Remove and destroy any egg masses you find. Scrape them off with a putty knife, stiff brush, or similar hand tool. Dispose of egg masses and other life stages in a container of hot, soapy water, or place them in a plastic bag, seal it, and set it in the sun.

Check each item off on your checklist as you go, and complete the requested information.

If a qualified, certified applicator performs the inspection, be sure you get a copy of the completed, signed checklist.

2)During your move, keep a copy of the completed checklist in the vehicle moving the goods in case a U.S. Department of Agriculture (USDA) or State official requests it at any point during your trip. If you are not driving, provide a copy to the driver. This completed checklist is an official certificate that will satisfy the requirements of all

non-infested States.

3)Once your move is completed, you may want to keep the checklist filed with your moving materials in case you need it in the future.

Where Do I Go For Help?

See the back of this flyer for photos of all gypsy moth life stages.

Learn more at www.YourMoveGypsyMothFree.com.

Contact your State Department of Agriculture or nearest USDA Animal and Plant Health Inspection Service (APHIS) office (www.aphis.usda.gov/planthealth/sphd).

USDA is an equal opportunity provider, employer, and lender.

This publication supersedes Program Aid No. 2065, “Your Next Move Gypsy Moth-Free,” which was published in October 2010.

Issued October 2013

Revised September 2018

Animal and Plant Health Inspection Service Program Aid No. 2147

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0104. The time required to complete this information collection is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

OMB APPROVED

0579-0104

EXP. DATE 09/30/2021

UNITED STATES DEPARTMENT OF AGRICULTURE ANIMAL AND PLANT HEALTH INSPECTION SERVICE PLANT PROTECTION AND QUARANTINE

GYPSY MOTH CHECKLIST AND

RECORD OF YOUR SELF-INSPECTION

Important: Make sure this checklist goes with your outdoor household items when you move

1. Originating Property Address

 

 

2. Date

 

 

 

 

3. Recreational or Camping Items

 

 

 

Backpacks

Ice Chests

Tarps

Basketball Backboards

Motorcycles

Tents

Bicycles

Motor Homes

Waders or Boots

Boats

Recreational Vehicles

Other: _____________________

Boat Trailers

Snowmobiles

None

Campers

Sports Equipment

 

 

 

 

 

 

4. Household Items

 

 

 

Air Conditioners

Ladders

Tanks for Propane and Oil

Barrels

Outdoor Doormats

Television Antennas

Cardboard and Wooden Boxes

Outdoor Thermometers

Trash Cans

Clothesline Poles

Refrigerators

Washing Machines

Clothespin Bags

Sheets of Plastic

Water Hoses

Empty Plant Containers

Shutters

Weather Vanes

Firewood*

Storage Sheds

Window Awnings

House Plants (taken outside

Storm/screen Doors and Windows

Other: _____________________

during the summer)

 

None

 

 

5. Building Materials

 

 

 

Bricks

Roofing Materials

Welding Equipment

Cement Mixing Tubs

Sewer Pipes

Workbenches

Cinder Blocks

Tools and Toolboxes

Other: _____________________

Lumber

Water Pipes

None

 

 

 

 

6. Yard and Garden Items

 

 

 

Animal Houses (doghouses,

Fertilizer Spreaders

Storage Sheds

rabbit hutches, etc.)

 

 

 

Barbecue Grills

Flagpoles

Swimming Pools

Birdbaths

Garden Tillers

Tractors and Trailers

Bird Feeders

Garden Tools

Trees, Shrubs, and Plants

Bird Houses

Lawnmowers

Trellises

Bug lights

Mailboxes

Wheelbarrows

Carts

Picnic Tables

Yard Decorations

Cold Frames

Porch or Patio Furniture

Other: _____________________

Driftwood

Signs and Posts

None

Fencing

Snow-blowers

 

 

 

 

 

 

7. Children’s Playthings

 

Other Outside Toys (like trucks or

Bicycles, tricycles

Swing sets

sand molds)

Playhouses

Tire Swings

Other: _____________________

Sandboxes

Wagons

None

Sleds, Toboggans

 

 

 

 

 

 

 

8. Other Items

 

 

 

Cars or Trucks

Farm Implements

None

Car Parts

Stored Tires (snow tires)

 

 

Car Ramps

Other: _____________________

 

 

 

 

 

 

Gypsy moth egg masses on a lawn mower (USDA/APHIS, Susan Lane)

Gypsy moth egg mass on a padlock (USDA/APHIS, Susan Lane)

Gypsy moth caterpillar (larva)

(Daniel Herms, The Ohio State University, Bugwood.org)

Gypsy moth pupae

(Pennsylvania Department of Conservation

and Natural Resources, Forestry Archive,

Bugwood.org)

Female (top) and male adult gypsy moths (USDA APHIS PPQ Archive, USDA/APHIS/PPQ, Bugwood.org)

Inspect anything that was stored outside

By signing my name in block 9 below, I agree that I am legally signing this document and affirming that I have inspected all outdoor household articles, whether included on this checklist or not, for all life stages of gypsy moth in accordance with the procedures on this form, as required by Title 7, Code of Federal Regulations, Part 301.45-4(a).

9.Signature and Date

11.Printed Name

10. Phone Number

12.Company Name (if applicable)

* To avoid spreading other tree pests, move only USDA- or State-certified, treated, and labeled firewood.

PPQ Form 377

SEP 2018

Note: The electronic signature function on this form works only if the user opens the file in Internet Explorer or Adobe Acrobat.

Document Data

Fact Name Description
Legal Requirement Individuals moving from a gypsy moth quarantine area to a non-quarantine area must inspect outdoor household items for gypsy moths.
Inspection Process Inspection can be done by the individual or a certified applicator. It involves checking for egg masses and other life stages of the gypsy moth.
Quarantine Area Identification To determine if you live in a quarantine area, visit www.YourMoveGypsyMothFree.com and check the U.S. map.
Checklist Importance The completed checklist serves as an official certificate that meets the requirements of non-infested states.
Inspection Timing It is advisable to complete the inspection on moving day, especially between April and August.
Disposal Method Egg masses should be destroyed by scraping them off and disposing of them in hot, soapy water or sealing them in a plastic bag.
Record Keeping Keep a copy of the completed checklist with your moving materials for future reference.
Governing Law This checklist is governed by Title 7, Code of Federal Regulations, Part 301.45-4(a).

How to Use California Gypsy Moth Checklist

Filling out the California Gypsy Moth Checklist is a straightforward process that ensures compliance with state regulations when moving from a quarantine area. After completing the checklist, it’s essential to keep it accessible during your move, as you may need to present it to officials if requested.

  1. Write the originating property address in the designated field.
  2. Fill in the date of your move.
  3. Inspect recreational or camping items. Check all that apply, including backpacks, tents, and bicycles.
  4. Move on to household items. Review and mark items such as air conditioners, washing machines, and outdoor doormats.
  5. Check building materials. List items like bricks, lumber, and tools.
  6. Inspect yard and garden items, including lawnmowers, birdhouses, and garden tools.
  7. Review children’s playthings. Include items like bicycles, swing sets, and sandboxes.
  8. Assess any other items, such as cars or trucks. Mark any relevant items in this section.
  9. Sign and date the checklist to affirm that you have inspected all outdoor household articles for gypsy moth life stages.
  10. Print your name and provide your phone number.
  11. If applicable, include your company name.

Once the checklist is completed, keep a copy with you during the move. This document serves as proof of compliance with regulations and may be required by officials along the way.

Key Facts about California Gypsy Moth Checklist

What is the California Gypsy Moth Checklist form?

The California Gypsy Moth Checklist form is a document that individuals must complete when moving from a gypsy moth quarantine area to a non-quarantine area. This form helps ensure that outdoor household items are inspected for gypsy moths, which can damage a wide variety of trees and shrubs.

Why is it important to check for gypsy moths before moving?

Gypsy moths are destructive pests that can harm over 300 types of trees and shrubs. Checking for them before moving helps protect your new neighborhood from potential infestations. Failure to inspect may lead to penalties, so it's crucial to comply with the law.

How can I find out if I live in a gypsy moth quarantine area?

You can determine if you live in a quarantine area by visiting www.YourMoveGypsyMothFree.com. Simply click on the U.S. map provided on the site to check your location. If you are in a quarantine area, you will need to inspect your belongings before moving.

What steps should I take if I live in a quarantine area and am moving?

First, you can either use the self-inspection checklist provided or hire a certified applicator to inspect your items. If possible, conduct the inspection on moving day. If you can't, protect your items by sealing them under a tarp or keeping them indoors. Make sure to inspect all surfaces of your outdoor items and remove any gypsy moth egg masses you find.

What should I do with any gypsy moth egg masses I find?

Remove the egg masses using a putty knife or stiff brush. Dispose of them by placing them in hot, soapy water or sealing them in a plastic bag and setting it in the sun. This will help eliminate any potential for infestation.

What do I need to do with the completed checklist?

Keep a copy of the completed checklist in the vehicle transporting your items. This serves as an official certificate that satisfies the requirements of non-infested states. If you are not driving, provide a copy to the driver. It’s also a good idea to keep the checklist filed with your moving materials for future reference.

Where can I find help or more information about gypsy moths?

For assistance, you can refer to the back of the checklist for photos of gypsy moth life stages. Additional information is available at www.YourMoveGypsyMothFree.com. You may also contact your State Department of Agriculture or the nearest USDA Animal and Plant Health Inspection Service (APHIS) office for guidance.

What happens if I fail to inspect my items?

If you are required to inspect your items and fail to do so, you may face penalties. It is essential to comply with the inspection requirement to avoid any legal issues and to protect your new community from potential infestations.

Is there a specific time frame for completing the inspection?

It is recommended to complete the inspection on moving day, especially if you are moving between April and August. If you cannot inspect on that day, ensure that your items are protected until you can complete the inspection.

Common mistakes

Filling out the California Gypsy Moth Checklist form is a crucial step when moving from a quarantine area to a non-quarantine area. However, many individuals make mistakes that can lead to complications. One common mistake is failing to inspect all outdoor household items thoroughly. People often overlook items like lawn equipment, bicycles, or even toys that may have been stored outside. It is essential to inspect every item, as gypsy moths can hide in unexpected places.

Another frequent error is not properly documenting the inspection process. Some individuals may forget to check off items on the checklist as they inspect them. This can lead to confusion later, especially if a USDA or State official requests proof of inspection. Keeping a clear record of what has been inspected is vital for compliance with the law.

Additionally, many people neglect to secure their items properly if they cannot complete the inspection on moving day. It is important to protect items from potential infestation by covering them with a tarp, keeping them indoors, or placing them in a closed moving truck. Failing to do so can result in penalties if an inspection reveals that items were not adequately protected.

Some individuals also make the mistake of not obtaining a copy of the completed checklist from a certified applicator if they choose to hire one. This checklist serves as an official certificate confirming that the inspection was conducted. Without this documentation, you may face difficulties proving compliance with the law.

Lastly, people sometimes forget to keep a copy of the checklist after the move is completed. Retaining this document can be beneficial for future reference or in case any questions arise regarding the inspection. By avoiding these common mistakes, individuals can ensure a smoother moving process and protect their new neighborhood from the gypsy moth.

Documents used along the form

When preparing to move from a gypsy moth quarantine area in California to a non-quarantine area, several forms and documents may accompany the California Gypsy Moth Checklist form. These documents help ensure compliance with regulations designed to prevent the spread of this destructive pest. Here’s a brief overview of other essential forms and documents you might encounter during this process.

  • Self-Inspection Checklist: This is often included with the Gypsy Moth Checklist. It provides a detailed guide for individuals inspecting their outdoor items for gypsy moth life stages. It helps ensure that nothing is overlooked during the inspection process.
  • Certificate of Inspection: Issued by a qualified certified applicator, this document confirms that an inspection has been conducted. It serves as proof that the inspected items are free from gypsy moths.
  • Moving Permit: Depending on the destination state, a moving permit may be required to transport items from a quarantine area. This permit ensures that the move complies with local regulations.
  • USDA Compliance Agreement: If you are a business involved in moving goods, this agreement may be necessary. It outlines the responsibilities of the parties involved in preventing pest spread.
  • Inventory List: This document details all items being moved. It can be useful for both the moving company and the individual to keep track of belongings and ensure nothing is left behind.
  • Proof of Residency: When moving, you may need to provide documentation that verifies your previous address in the quarantine area. This can include utility bills or lease agreements.
  • State Agricultural Inspection Form: Some states require this form to be filled out upon arrival. It allows state officials to verify that no gypsy moths are present in the transported items.
  • Emergency Contact Information: This document provides details of who to contact in case of any issues during the move, particularly related to pest inspections.
  • Moving Company Contract: This is the agreement between you and the moving company. It outlines the services provided and any liabilities involved in the moving process.
  • Insurance Policy Documentation: If you have purchased insurance for your move, this document outlines coverage details and what to do in case of loss or damage during transport.

Understanding these documents can help ensure a smooth transition when moving from a gypsy moth quarantine area. Being well-prepared not only protects your belongings but also contributes to the health of the new environment you are entering.

Similar forms

  • California Pesticide Use Reporting (PUR) Form: Similar to the Gypsy Moth Checklist, this form requires individuals to report the use of pesticides, ensuring that harmful substances do not spread uncontrollably. Both documents emphasize the importance of inspection and accountability in protecting public health and the environment.
  • California Invasive Species Reporting Form: This form is used to report sightings of invasive species, including pests like the gypsy moth. Just as the Gypsy Moth Checklist mandates inspections to prevent infestations, the invasive species form aims to identify and mitigate threats to local ecosystems.
  • California Department of Fish and Wildlife (CDFW) Wildlife Incident Report: This report is similar in that it documents incidents involving wildlife, including potential threats from invasive species. Both forms require detailed information to help authorities manage and protect native species.
  • USDA Animal and Plant Health Inspection Service (APHIS) Inspection Certificate: Like the Gypsy Moth Checklist, this certificate verifies that certain plants or materials have been inspected and are free from pests. Both documents serve as proof of compliance with regulations designed to prevent the spread of harmful species.
  • California Nursery License Application: This application ensures that nurseries comply with regulations to prevent pest outbreaks, similar to how the Gypsy Moth Checklist requires inspections before moving items. Both documents aim to safeguard agricultural health.
  • California Environmental Quality Act (CEQA) Compliance Checklist: This checklist is used to assess potential environmental impacts of projects. Like the Gypsy Moth Checklist, it emphasizes thorough examination and documentation to ensure compliance with environmental laws, protecting ecosystems from harmful effects.

Dos and Don'ts

When filling out the California Gypsy Moth Checklist form, it is essential to follow certain guidelines to ensure compliance and protect your new environment. Below is a list of things you should and shouldn't do.

  • Do inspect all outdoor household items thoroughly for gypsy moth egg masses.
  • Do use the self-inspection checklist provided on the form.
  • Do remove and destroy any egg masses you find immediately.
  • Do keep a copy of the completed checklist with you during your move.
  • Do seal items under a tarp or keep them indoors if you cannot inspect them on moving day.
  • Don't ignore the inspection if you are moving from a quarantine area.
  • Don't forget to obtain a signed copy of the checklist if a certified applicator performs the inspection.

By adhering to these guidelines, you can help prevent the spread of gypsy moths and ensure a smooth transition to your new home.

Misconceptions

Here are four common misconceptions about the California Gypsy Moth Checklist form:

  • Only people in quarantine areas need to worry about gypsy moths. Many believe that if they are not in a quarantine area, they do not need to inspect their items. However, anyone moving from a quarantine area to a non-quarantine area must inspect their belongings, regardless of their current location.
  • The checklist is optional. Some individuals think that completing the checklist is not mandatory. In reality, it is a legal requirement for those moving from a quarantine area. Failing to complete the checklist can lead to penalties.
  • Inspection is complicated and time-consuming. Many people assume that inspecting for gypsy moths is a difficult task. In fact, the inspection process is straightforward and can be done quickly. With a little care, anyone can complete it effectively.
  • Once the checklist is completed, it is no longer needed. Some believe that after moving, the checklist can be discarded. It is advisable to keep a copy of the checklist with your moving materials. This documentation may be useful for future reference or if you need to prove compliance.

Key takeaways

  • Legal Requirement: If you're moving from a gypsy moth quarantine area to a non-quarantine area, you must inspect your outdoor household items for gypsy moths.
  • Inspection Process: Use the self-inspection checklist provided or hire a certified applicator to perform the inspection.
  • Timing: Complete the inspection on moving day, especially if moving between April and August. If not possible, protect items by sealing them.
  • Checklist Importance: Keep a copy of the completed checklist in your vehicle during the move. It serves as an official certificate for non-infested states.
  • Disposal of Egg Masses: Remove any gypsy moth egg masses you find using a putty knife or stiff brush. Dispose of them in hot, soapy water or a sealed plastic bag.
  • Future Reference: After your move, file the checklist with your moving materials for potential future needs.
  • Resources for Assistance: For help, visit www.YourMoveGypsyMothFree.com or contact your State Department of Agriculture.