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Mosquito Concern Report

2. Citizen First Name*

3. Citizen Last Name*

5. Citizen Address*

7. Citizen Phone Number*

9. Citizen Email Address*

11. If this report concerns standing water, is the standing water on:

    1. Private property
    2. Public property
    3. Not sure

13. Address of standing water, if different from your own:

15. Description of standing water, including where the standing water is located to allow City staff to easily find the issue when investigating:

17. If this report concerns mosquitoes, what time of day do you notice the mosquitoes?

    1. Morning
    2. Afternoon
    3. Evening
    4. All of the above

19. If you have mosquito bites, where on your body are the bites located?

    1. Below the knees
    2. All over body

21. If this report concerns spraying for mosquitoes, what is your concern?

    1. Why are you spraying my neighborhood?
    2. Why aren't you spraying my neighborhood?
    3. Other

23. If you answered Other to the question above, please explain:

25. Any other information that you would like to share with City staff so that we can investigate your mosquito concern efficiently:

27. Do you want a City staff person to follow up with you regarding this report?*

    1. Yes
    2. No

29. Thank you for submitting a report. Please remember that the best protection against West Nile Virus is to follow the four D’s: (1) Dress to protect: wear long sleeves and long pants. (2) Dusk, Daytime and Dawn: protect yourself against mosquitoes anytime you are outside. (3) Defend: wear insect repellent with DEET, Picaridin, Oil of Lemon Eucalyptus or an effective alternative. (4) Drain standing water: eliminate any water that stands for longer than 5 days or treat water with larvicide according to the label.

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33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field