Fill Out Your California Gypsy Moth Checklist Form
The California Gypsy Moth Checklist form highlights critical steps for individuals moving from a gypsy moth quarantine area to a non-quarantine zone. It is essential to conduct a thorough inspection of all outdoor household items, as mandated by law, to prevent this invasive species from infesting new locations. The checklist simplifies the inspection process, which includes identifying and removing gypsy moth egg masses and other life stages that may cling to various belongings. Individuals must either self-inspect or hire a certified professional to perform the assessment, with a specific emphasis on completing this inspection on moving day, particularly during the peak gypsy moth season from April to August. A copy of the signed checklist must accompany the moving vehicle, as it serves as an official certificate proving compliance with federal laws. This proactive measure not only protects the environment but also prevents potential penalties for failing to meet legal obligations. Resources and further assistance are readily available, ensuring that everyone can navigate these requirements effectively and keep their new neighborhoods free from gypsy moths.
California Gypsy Moth Checklist Example
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SY MOTH |
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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
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
I Live in a Quarantine Area and Am Moving to a
1)Use the
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
•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
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
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
OMB APPROVED
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
Important: Make sure this checklist goes with your outdoor household items when you move
1. Originating Property Address |
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2. Date |
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3. Recreational or Camping Items |
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Backpacks |
Ice Chests |
Tarps |
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Basketball Backboards |
Motorcycles |
Tents |
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Bicycles |
Motor Homes |
Waders or Boots |
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Boats |
Recreational Vehicles |
Other: _____________________ |
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Boat Trailers |
Snowmobiles |
None |
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Campers |
Sports Equipment |
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4. Household Items |
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Air Conditioners |
Ladders |
Tanks for Propane and Oil |
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Barrels |
Outdoor Doormats |
Television Antennas |
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Cardboard and Wooden Boxes |
Outdoor Thermometers |
Trash Cans |
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Clothesline Poles |
Refrigerators |
Washing Machines |
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Clothespin Bags |
Sheets of Plastic |
Water Hoses |
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Empty Plant Containers |
Shutters |
Weather Vanes |
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Firewood* |
Storage Sheds |
Window Awnings |
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House Plants (taken outside |
Storm/screen Doors and Windows |
Other: _____________________ |
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during the summer) |
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None |
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5. Building Materials |
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Bricks |
Roofing Materials |
Welding Equipment |
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Cement Mixing Tubs |
Sewer Pipes |
Workbenches |
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Cinder Blocks |
Tools and Toolboxes |
Other: _____________________ |
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Lumber |
Water Pipes |
None |
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6. Yard and Garden Items |
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Animal Houses (doghouses, |
Fertilizer Spreaders |
Storage Sheds |
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rabbit hutches, etc.) |
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Barbecue Grills |
Flagpoles |
Swimming Pools |
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Birdbaths |
Garden Tillers |
Tractors and Trailers |
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Bird Feeders |
Garden Tools |
Trees, Shrubs, and Plants |
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Bird Houses |
Lawnmowers |
Trellises |
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Bug lights |
Mailboxes |
Wheelbarrows |
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Carts |
Picnic Tables |
Yard Decorations |
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Cold Frames |
Porch or Patio Furniture |
Other: _____________________ |
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Driftwood |
Signs and Posts |
None |
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Fencing |
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7. Children’s Playthings |
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Other Outside Toys (like trucks or |
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Bicycles, tricycles |
Swing sets |
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sand molds) |
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Playhouses |
Tire Swings |
Other: _____________________ |
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Sandboxes |
Wagons |
None |
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Sleds, Toboggans |
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8. Other Items |
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Cars or Trucks |
Farm Implements |
None |
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Car Parts |
Stored Tires (snow tires) |
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Car Ramps |
Other: _____________________ |
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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
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
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.
Form Characteristics
| Fact Name | Description |
|---|---|
| Legal Requirement | If you leave a gypsy moth quarantine area, you must inspect your outdoor household items for gypsy moth life stages before moving to a non-quarantine area. |
| Self-Inspection Process | Individuals can either use a self-inspection checklist or hire a certified applicator to check for the gypsy moth. The inspection is straightforward and can be completed on moving day if possible. |
| Record Keeping | A completed checklist serves as an official certificate that fulfills the requirements for non-infested states. It's wise to keep this document with moving paperwork after the move. |
| Gypsy Moth Impact | Gypsy moths can damage over 300 types of trees and shrubs. It is essential to prevent their spread to protect local ecosystems. |
| Governing Law | This checklist is governed by Title 7, Code of Federal Regulations, Part 301.45-4(a), which outlines the regulations regarding gypsy moth inspections. |
Guidelines on Utilizing California Gypsy Moth Checklist
Completing the California Gypsy Moth Checklist is essential for anyone moving from a gypsy moth quarantine area to a non-quarantine area. This process helps ensure that you and your belongings comply with necessary regulations. Follow the steps below to accurately fill out the checklist.
- Begin by entering your Originating Property Address in the designated area.
- Fill in the Date of your move.
- Check the appropriate items in the section for Recreational or Camping Items, including:
- Backpacks
- Ice Chests
- Motorcycles
- Boats
- Camping Gear, etc.
- Other: _____________________
- None
- Proceed to the Household Items section and inspect all items, marking them as necessary. These should include:
- Outdoor Doormats
- Refrigerators
- Clothesline Poles
- Washing Machines, etc.
- Other: _____________________
- None
- In the Building Materials section, check off any items that apply, such as:
- Tools and Toolboxes
- Cement Mixing Tubs
- Lumber, etc.
- Other: _____________________
- None
- Next, review the Yard and Garden Items category, marking the relevant items:
- Garden Tools
- Lawnmowers
- Bird Feeders, etc.
- Other: _____________________
- None
- Continue to the Children’s Playthings section. Inspect and check if any apply, including:
- Bicycles
- Playhouses
- Sandboxes, etc.
- Other: _____________________
- None
- Lastly, fill out the Other Items section, marking any items such as:
- Cars or Trucks
- Stored Tires
- Other: _____________________
- None
- After inspecting all items, sign and date the checklist in block 9. Your signature affirms compliance with inspection requirements.
- Print your Name in block 11 and provide your Phone Number in block 10.
- If applicable, include your Company Name in block 12.
Once you have completed the checklist, keep a copy with you during the move. This document is necessary if any USDA or State officials request it. After the move, consider keeping the checklist filed with your other moving materials for future reference.
What You Should Know About This Form
What is the purpose of the California Gypsy Moth Checklist form?
The California Gypsy Moth Checklist form serves as a self-inspection tool for individuals moving from areas under gypsy moth quarantine to non-quarantine areas. This inspection is required by law to ensure that all life stages of the gypsy moth are removed from outdoor household items before relocating. By completing this checklist, movers can prevent the spread of this destructive pest that can harm a variety of trees and shrubs.
How can I determine if I live in a gypsy moth quarantine area?
You can find out if you reside in a gypsy moth quarantine area by visiting www.YourMoveGypsyMothFree.com. The site features an interactive U.S. map that clearly indicates the designated quarantine areas. If you do not see your location marked as a quarantine area, the inspection requirement does not apply to you.
What steps should I take if I am moving from a quarantine area?
If you are moving from a quarantine area, the legal requirement is to either perform a self-inspection using the checklist or hire a qualified, certified applicator. During your self-inspection, you must carefully check outdoor items like furniture and vehicles for gypsy moth egg masses. Any found should be removed and destroyed. Make sure to keep a copy of the completed checklist during your move, as it may be requested by officials.
What should I do with any egg masses I find?
Upon discovering any gypsy moth egg masses during your inspection, they must be removed immediately. Use tools such as a putty knife or stiff brush to scrape them off. After removal, dispose of them by placing them in a container of hot soapy water or sealing them in a plastic bag and leaving it in direct sunlight. This will ensure that the eggs do not survive the removal process.
What should I do with the completed checklist after my move?
Once your move is completed, it’s advisable to keep the completed checklist filed with your moving materials. This document serves not only as official proof of your inspection but may also be helpful for future reference, especially if you are asked by officials about your compliance with the gypsy moth inspection requirements.
Where can I find additional resources or assistance?
Common mistakes
When filling out the California Gypsy Moth Checklist form, many individuals inadvertently make common mistakes that can result in penalties or delays. Understanding these errors can help ensure compliance with the law and protect the new environment from the invasive gypsy moth.
One significant mistake is failing to inspect all outdoor household items thoroughly. People often assume that only larger items, like furniture or vehicles, need attention. In reality, smaller items such as children's toys, grills, and garden tools require inspection as well. Every outdoor item could harbor gypsy moth life stages, and overlooking any could lead to legal issues.
Another frequent error involves lacking documentation of the inspection. Many forget to keep a copy of the completed checklist in the vehicle transporting their goods. This checklist serves as proof for USDA or state officials during inspections. Not having this documentation readily available can create unnecessary complications and delays during the moving process.
Some individuals also mistakenly proceed with their move without removing or destroying any identified gypsy moth egg masses. It's crucial to follow the recommended methods to dispose of these pests properly. Many choose to simply relocate egg masses instead of disposing of them correctly. Such actions could inadvertently introduce the pest into a non-quarantine area.
Additionally, there can be confusion about the timelines for inspections. It is essential to conduct the self-inspection on moving day or, if that isn't possible, to protect the items immediately. However, people often forget to apply protective measures like sealing items in tarps or storing them indoors. This could lead to potential infestation during transport.
Lastly, many overlook the importance of obtaining a signature on the checklist. A signature is required to affirm the inspection has been completed according to legal requirements. Skipping this step may not only invalidate the checklist but could also result in fines or additional scrutiny from officials. Everyone should remember that completeness and accuracy are key to successfully navigating this process.
Documents used along the form
The movement of household items from a gypsy moth quarantine area to a non-quarantine area involves a crucial checklist and various accompanying documents. Understanding these related forms is essential in ensuring compliance with state and federal regulations, thereby safeguarding the environment and local ecosystems. Here is a brief overview of documents that often accompany the California Gypsy Moth Checklist form.
- Self-Inspection Checklist: This is often found on the back of the Gypsy Moth Checklist, detailing steps that individuals can follow to perform their own inspection of household items before moving.
- Inspection Report: If a certified applicator carries out the inspection, they will provide an inspection report. This report confirms that the inspection occurred, detailing the items checked and any issues found.
- Certificate of Inspection: This document serves as proof that an item has been inspected and deemed free of gypsy moth life stages. It is essential for legal movement between regions.
- Firewood Certification: For those moving firewood, a certification is required to ensure that it is treated and labeled to comply with regulations aiming to prevent the spread of invasive pests.
- Moving Contract: A formal agreement between the mover and the person relocating. This document outlines the terms and responsibilities for the transportation of household goods.
- Customs Declaration Form: If moving across state lines, a customs declaration form may be needed. It helps authorities ensure that no restricted items are being transported.
- Proof of Residency: Documents like a utility bill can provide evidence of residency in a quarantine area, reinforcing the need for the inspection checklist when moving.
- List of Outdoor Items: A detailed inventory of all outdoor items that need inspection, ensuring nothing is overlooked during the inspection process.
- Contact Information for State Agriculture Department: Keeping on hand the contact details for the local State Department of Agriculture or USDA office can streamline communication if issues arise during the moving process.
Being aware of these forms and their significance is critical for anyone moving from a quarantine area. This knowledge not only helps avoid legal complications but also plays a role in protecting communities from invasive species. Staying informed and prepared can lead to smoother transitions and a more responsible approach to moving household goods.
Similar forms
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The Pest Control Inspection Form serves primarily to verify treatment against pests before moving goods. Like the Gypsy Moth Checklist, this document requires an inspection of items for any signs of pests. Both forms may involve a certified professional performing the inspection and provide critical information on compliance to avoid fines.
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The Moving Checklist is designed to help individuals manage tasks before and during a move. Similar to the Gypsy Moth Checklist, it covers important actions that must be taken to ensure everything is completed properly. Each checklist serves as a guide for necessary steps that contribute to a successful relocation.
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The Animal Inspection Report requires individuals to ensure that animals are free from specific pests or diseases before transport. This document aligns with the Gypsy Moth Checklist's requirements for a thorough inspection, where both lists aim to prevent the spread of harmful pests from one area to another.
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The Firewood Transport Certificate ensures that firewood being moved is treated and free from invasive pests. This form shares a common goal with the Gypsy Moth Checklist, emphasizing the importance of inspecting and certifying items to protect the environment and local ecosystems.
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The Certificate of Compliance is issued to confirm that an individual or business adheres to state regulations regarding pest control. Just like the Gypsy Moth Checklist, this document involves a verification process, ensuring that specific criteria have been met to protect public health and safety.
Dos and Don'ts
When filling out the California Gypsy Moth Checklist form, keep these dos and don'ts in mind:
- Do carefully inspect all surfaces and crevices of your outdoor items.
- Do remove and destroy any gypsy moth egg masses found during your inspection.
- Do check off each item on your checklist as you inspect it.
- Do keep a copy of the completed checklist in the vehicle during your move.
- Do file the checklist with your moving materials for future reference.
- Don't skip the inspection if you're moving from a quarantine area.
- Don't leave any egg masses on your items before moving.
Misconceptions
Misconceptions about the California Gypsy Moth Checklist form can lead to confusion and frustration for those preparing to move. Understanding these misconceptions is vital for compliance and for protecting new neighborhoods from this invasive pest.
- Only residential areas are affected by gypsy moth regulations. In fact, both residential and commercial properties must comply with the gypsy moth inspection requirements. If any items, whether personal or business-related, have been stored outside, they should be inspected.
- The checklist is optional for individuals moving out of a quarantine area. This is false. The checklist is mandatory for anyone moving from a gypsy moth quarantine area to a non-quarantine area. Failing to complete the checklist may lead to penalties, including potential fines.
- Inspection of items is a complicated and time-consuming process. Many people assume that checking for gypsy moths requires extensive knowledge and intricate procedures. However, a self-inspection is straightforward. By following clear steps, individuals can inspect their items in under an hour.
- Only visible gypsy moths must be reported. This misconception overlooks the importance of inspecting for all life stages, including egg masses and larvae. The environmental risks from even a few unnoticed egg masses can be significant, as they can result in widespread infestations.
Key takeaways
The California Gypsy Moth Checklist form is an essential tool for anyone moving from a gypsy moth quarantine area. Understanding how to fill it out correctly and the importance of its use can make the process smoother and ensure compliance with state laws.
- Legal Requirement: Before moving, individuals must inspect outdoor household items for gypsy moths if they are relocating from a quarantine area to a non-quarantine area.
- Inspection Process: Inspect all surfaces and crevices on items like furniture, lawn equipment, and vehicles. Remove any egg masses found using appropriate tools.
- Checklist Completion: Check off each item as inspected and fill in necessary information on the form to create a record of compliance.
- Moving Day Inspection: Complete the inspection on moving day if possible. If not, protect items from contamination by sealing them under a tarp or in a closed moving truck.
- Copy for Travel: Keep a copy of the completed checklist in the vehicle carrying the goods. This serves as a certification of compliance during the journey.
- Post-Move Storage: After the move, retain the checklist with moving materials. This can be useful for future reference or if any issues arise.
- Resources for Help: Visit www.YourMoveGypsyMothFree.com or contact the local State Department of Agriculture for assistance or further information.
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