Homepage Blank California Gypsy Moth Checklist Form
Outline

The California Gypsy Moth Checklist form is an essential tool for individuals planning to move from areas affected by gypsy moth infestations to regions free from this invasive pest. This checklist serves as a legal requirement, ensuring that outdoor household items are thoroughly inspected for any signs of gypsy moth life stages before relocation. The form outlines the steps necessary for self-inspection, including checking various outdoor articles such as patio furniture, lawn equipment, and vehicles. It emphasizes the importance of removing and destroying any egg masses found during the inspection process, as these can lead to significant ecological damage. For those living in quarantine areas, the checklist provides guidance on how to meet legal obligations, including the option to hire a certified applicator for inspection. Additionally, it stresses the need to keep a copy of the completed checklist during the move, which may be requested by officials from the U.S. Department of Agriculture or state agencies. Resources for further assistance are also included, making it easier for individuals to comply with the law and protect their new neighborhoods from potential infestations.

Sample - California Gypsy Moth Checklist Form

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or 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
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
y
our 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
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
Tents
Bicycles
Motor Homes
Waders or Boots
Boats
Other: _____________________
Boat Trailers
Snowmobiles
None
Campers
4. Household Items
Air Conditioners
Tanks for Propane and Oil
Barrels
Television Antennas
Cardboard and Wooden Boxes
Trash Cans
Clothesline Poles
Washing Machines
Clothespin Bags
Water Hoses
Empty Plant Containers
Weather Vanes
Firewood*
Window Awnings
House Plants (taken outside
during the summer)
Other: _____________________
None
5. Building Materials
Bricks
Welding Equipment
Cement Mixing Tubs
Sewer Pipes
Workbenches
Cinder Blocks
Other: _____________________
Lumber
Water Pipes
None
6. Yard and Garden Items
Animal Houses (doghouses,
rabbit hutches, etc.)
Fertilizer Spreaders Storage Sheds
Barbecue Grills
Swimming Pools
Birdbaths
Tractors and Trailers
Bird Feeders
Garden Tools
Trees, Shrubs, and Plants
Bird Houses
Trellises
Bug lights
Mailboxes
Wheelbarrows
Carts
Yard Decorations
Cold Frames
Other: _____________________
Driftwood
None
Fencing
7. Children’s Playthings
Other
Outside Toys (like trucks or
sand molds)
Bicycles, tricycles
Swing sets
Playhouses Tire Swings Other: _____________________
Sandboxes
None
Sleds, Toboggans
8. Other Items
Cars or Trucks
Farm Implements
None
Car Parts
Car Ramps
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
10. Phone Number
11. Printed Name
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
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)
Note: The electronic signature function on this form works only if the user opens the file in Internet
Explorer or Adobe Acrobat.

Form Information

Fact Name Details
Legal Requirement Individuals moving from a gypsy moth quarantine area to a non-quarantine area must inspect their outdoor household items for gypsy moths and remove all life stages before moving.
Inspection Process Inspect outdoor items such as furniture and equipment for gypsy moth egg masses, using tools like putty knives or stiff brushes to remove them.
Checklist Importance The completed checklist serves as an official certificate that satisfies the requirements of non-infested states during transport.
Quarantine Area Verification Residents can verify their quarantine status by visiting www.YourMoveGypsyMothFree.com and checking the U.S. map provided.
Governing Law This checklist is governed by Title 7, Code of Federal Regulations, Part 301.45-4(a), which outlines the inspection requirements for gypsy moths.

Detailed Guide for Filling Out California Gypsy Moth Checklist

Filling out the California Gypsy Moth Checklist form is an important step when moving from a gypsy moth quarantine area to a non-quarantine area. This checklist helps ensure that you have inspected your outdoor household items for gypsy moths, protecting your new neighborhood from potential infestations. Follow these steps to complete the form accurately.

  1. Enter the originating property address where you are moving from.
  2. Fill in the date of the inspection.
  3. Inspect your recreational or camping items. Check all applicable items such as backpacks, tents, bicycles, and more. List any other items in the space provided.
  4. Move on to your household items. Carefully check items like air conditioners, outdoor doormats, and washing machines. Note any other items not listed.
  5. Next, inspect building materials. This includes bricks, lumber, and tools. Again, list any additional materials as necessary.
  6. Check your yard and garden items. Look at items like lawnmowers, garden tools, and outdoor furniture. Include any other relevant items in the provided space.
  7. Review children’s playthings. Inspect bicycles, swing sets, and other toys. Add any other toys as needed.
  8. Assess other items such as cars, trucks, or stored tires. Document any additional items in the space provided.
  9. Sign and date the form in block 9 to affirm that you have inspected all outdoor articles for gypsy moth life stages.
  10. Print your name in block 11 and provide your phone number in block 10.
  11. If applicable, include your company name in block 12.

After completing the checklist, keep a copy with you during your move. This document may be requested by officials, and it serves as proof that you have fulfilled the inspection requirement. Once settled, consider filing the checklist with your moving materials for future reference.

Obtain Answers on California Gypsy Moth Checklist

  1. 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. It serves as proof that you have inspected your outdoor household items for gypsy moth life stages and have taken necessary actions to prevent their spread.

  2. Who needs to fill out the checklist?

    If you live in a gypsy moth quarantine area and are planning to move to a non-quarantine area, you are required to fill out the checklist. This requirement is in place to protect new neighborhoods from the potential damage caused by gypsy moths.

  3. How do I know if I live in a quarantine area?

    To determine if you reside in a gypsy moth quarantine area, visit www.YourMoveGypsyMothFree.com. This website provides an interactive U.S. map that indicates the quarantine status of different regions.

  4. What steps should I take to inspect my items?

    When inspecting your outdoor household items, follow these steps:

    • Carefully check all surfaces and crevices of items like patio furniture, lawn equipment, and vehicles for gypsy moth egg masses.
    • Remove and destroy any egg masses you find using a putty knife or stiff brush.
    • Dispose of egg masses in hot, soapy water or seal them in a plastic bag and place it in the sun.
    • Check off each item on your checklist as you complete the inspection.
  5. What should I do with the completed checklist?

    Keep a copy of the completed checklist in the vehicle transporting your items during the move. This document serves as an official certificate that may be requested by USDA or State officials. After your move, it’s wise to keep the checklist filed with your moving materials for future reference.

  6. What if I cannot complete the inspection on moving day?

    If you’re unable to conduct the inspection on the day of your move, protect your items from potential infestation. You can do this by sealing them under a tarp, keeping them indoors, or storing them in a closed moving truck until the inspection can be completed.

  7. Can I hire someone to inspect my items?

    Yes, you can hire a qualified certified applicator to perform the inspection for you. If you choose this option, ensure that you receive a copy of the completed and signed checklist from the applicator.

  8. Where can I find more information or help?

    For additional resources, visit www.YourMoveGypsyMothFree.com. You can also contact your State Department of Agriculture or the nearest USDA Animal and Plant Health Inspection Service (APHIS) office for assistance.

  9. What happens if I don’t comply with the law?

    Failing to inspect your items when required can result in penalties. It's essential to comply with the law not only to avoid fines but also to protect the environment and your new community from the gypsy moth's destructive impact.

Common mistakes

Filling out the California Gypsy Moth Checklist form is essential for anyone moving from a quarantine area. However, many people make common mistakes that can lead to complications. One of the most frequent errors is failing to inspect all items thoroughly. It’s important to check every surface and crevice of outdoor household items. Overlooking even a small area can result in penalties, so take the time to inspect everything carefully.

Another common mistake is not completing the checklist during the inspection. Some individuals forget to check off items as they go. This can create confusion later on. Keeping a detailed record of what has been inspected is crucial. Remember, the checklist serves as an official certificate. If it’s incomplete, it may not satisfy the requirements of non-infested states.

Many people also neglect to keep a copy of the completed checklist during the move. This is a significant oversight. Having the checklist on hand is important in case a USDA or state official requests it. If you’re not driving, ensure that the driver has a copy. This simple step can save you from unnecessary delays or penalties.

Some individuals mistakenly believe that they can complete the inspection at any time. However, it’s recommended to conduct the inspection on moving day, especially if you’re moving between April and August. Delaying the inspection can increase the risk of infestation. If you can’t inspect on the day of the move, ensure that the items are properly protected, such as by sealing them under a tarp.

Another frequent error is not disposing of found egg masses correctly. It’s essential to remove and destroy any egg masses discovered during the inspection. Simply scraping them off is not enough; they must be disposed of in hot, soapy water or sealed in a plastic bag and placed in the sun. Proper disposal helps prevent the spread of these pests.

Some people also overlook the importance of understanding whether they live in a quarantine area. It’s crucial to check the U.S. map at www.YourMoveGypsyMothFree.com before moving. If you mistakenly believe you’re not in a quarantine area, you may skip the inspection altogether, which can lead to serious consequences.

Lastly, many individuals fail to keep the checklist filed with their moving materials after the move. This document can be useful in the future, especially if any questions arise about your compliance with the gypsy moth inspection requirements. Keeping it organized can save you time and hassle down the road.

Documents used along the form

The California Gypsy Moth Checklist form is a critical document for individuals moving from a gypsy moth quarantine area to a non-quarantine area. To ensure compliance with the law, several other forms and documents may be utilized in conjunction with this checklist. Below is a list of these related documents, along with brief descriptions of their purposes.

  • Self-Inspection Checklist: This document provides a detailed guide for individuals to inspect their outdoor household items for gypsy moth life stages. It outlines specific items to check and the procedures for removing any found egg masses.
  • Inspection Certificate: Issued by a certified applicator, this certificate confirms that a professional inspection was conducted on the outdoor household items. It serves as proof of compliance with the inspection requirement.
  • Moving Permit: Some states may require a moving permit for transporting items from a quarantine area. This document ensures that the move is authorized and compliant with local regulations regarding gypsy moth infestations.
  • USDA Inspection Report: If a USDA official inspects the moving vehicle or items, they may provide a report detailing the findings. This report can be essential for demonstrating compliance with federal regulations.
  • Quarantine Area Map: This map helps individuals determine whether they reside in a gypsy moth quarantine area. It is a useful reference for confirming legal obligations related to inspections.
  • Disposal Guidelines: This document outlines the proper methods for disposing of gypsy moth egg masses and other life stages. Following these guidelines is crucial for preventing the spread of the pest.

Utilizing these documents in conjunction with the California Gypsy Moth Checklist form helps ensure compliance with state and federal regulations. Proper inspection and documentation protect both the individual and the community from the potential threats posed by the gypsy moth.

Similar forms

  • California Pesticide Use Reporting Form: Similar to the Gypsy Moth Checklist, this form requires individuals to document their inspections and use of pesticides. Both documents emphasize the importance of compliance with state regulations to protect the environment and public health.
  • California Invasive Species Notification Form: This form also serves to inform individuals about the presence of invasive species, similar to how the Gypsy Moth Checklist informs about gypsy moths. Both documents require individuals to take action to prevent the spread of harmful organisms.
  • California Firewood Compliance Certificate: Like the Gypsy Moth Checklist, this certificate ensures that firewood is free from pests before it is transported. Both documents aim to prevent the movement of pests that can harm local ecosystems.
  • California Agricultural Inspection Report: This report documents inspections of agricultural products and equipment, similar to the Gypsy Moth Checklist. Both forms are critical for maintaining agricultural health and preventing pest infestations.
  • California Animal Health Certificate: This certificate is required for the movement of animals and ensures they are free from disease. It parallels the Gypsy Moth Checklist in that both require verification of health status before movement to protect communities.

Dos and Don'ts

When filling out the California Gypsy Moth Checklist form, it is essential to follow specific guidelines to ensure compliance with the law and protect your new neighborhood. Below is a list of ten things you should and shouldn't do during this process.

  • Do inspect all outdoor household items thoroughly for gypsy moth egg masses.
  • Don't overlook crevices and surfaces; they can hide egg masses.
  • Do use a putty knife or stiff brush to remove any egg masses you find.
  • Don't dispose of egg masses in regular trash; use hot, soapy water or seal them in a plastic bag and place them in the sun.
  • Do check off each item on your checklist as you inspect it.
  • Don't forget to keep a copy of the completed checklist with you during the move.
  • Do hire a certified applicator if you are unsure about conducting the inspection yourself.
  • Don't wait until the last minute to complete the inspection; do it on moving day if possible.
  • Do file the checklist with your moving materials for future reference.
  • Don't ignore the law; failing to inspect can lead to penalties.

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

Misconceptions

Misconceptions about the California Gypsy Moth Checklist form can lead to confusion and potential penalties. Here are ten common misunderstandings:

  • Only homeowners need to worry about the checklist. The law applies to anyone moving from a quarantine area, including renters and businesses.
  • I don’t have to inspect items if I’m moving locally. The requirement applies regardless of distance, as long as you are moving from a quarantine area.
  • The checklist is optional. The checklist is a legal requirement for moving to a non-quarantine area and must be completed.
  • Inspection is complicated and time-consuming. The self-inspection process is straightforward and typically takes about one hour.
  • I can skip inspecting items stored indoors. Any outdoor household items must be inspected, regardless of where they are stored.
  • Egg masses are easy to identify, so I don’t need to worry. Gypsy moth egg masses can be hard to spot; thorough inspection is crucial.
  • Only certain items need to be inspected. All outdoor household items, including recreational and garden equipment, must be checked.
  • Once I move, I can discard the checklist. It is advisable to keep the checklist for future reference, as it may be needed later.
  • Hiring a professional is the only way to comply. You can perform a self-inspection, but hiring a certified applicator is an option if preferred.
  • Penalties for non-compliance are rare. Failing to inspect can lead to fines or other penalties, making compliance essential.

Understanding these points can help ensure a smooth moving process and compliance with the law.

Key takeaways

Key Takeaways for Filling Out and Using the California Gypsy Moth Checklist Form:

  1. Before moving from a gypsy moth quarantine area to a non-quarantine area, you must inspect all outdoor household items for gypsy moth life stages.
  2. To determine if you live in a quarantine area, visit www.YourMoveGypsyMothFree.com and check the U.S. map.
  3. Use the self-inspection checklist provided or hire a certified applicator for the inspection. It is advisable to conduct this inspection on the day of your move.
  4. During the inspection, carefully check all surfaces of outdoor items, remove any egg masses found, and dispose of them properly.
  5. Keep a copy of the completed checklist with you during your move. This serves as proof that you have complied with legal requirements.
  6. After your move, retain the checklist with your moving materials for future reference, as it may be needed later.