Glow worm survey form

Please print out the form, fill it in and post it to 34 Fennels Way, Flackwell Heath, High Wycombe, Bucks HP10 9BY.

Name:

Postal address and phone number (optional, but it helps us):

E-mail address :

Name of site (your choice of name):

County:

Ordnance Survey Grid Reference (two letters and six numbers, eg TQ 055867. Click here for help in giving map references):

For new sites, please give details of the location of the site in relation to roads, railways and other nearby landmarks.

Details of visits:





Number of
Visit Date Time      Conditions* Males** Females Larvae




(on females) (glowing) (occasional glow)
1
2
3
4
5
6
7
8

*Conditions: Choose from Dry, Raining, Wet ground (ie droplets on vegetation), Windy. Also give night time temperature if you can.
** Males are usually only obvious when seen with females

Type of site (please click):

Nature Reserve Garden Roadside Railway Waterside Sea cliff Quarry Grassland Other

Position of glow worms (click on more than one if necessary):

Short grass Long grass Under trees In hedge On path On gravel or stones Other

Is there any permanent open water within 100 metres of the glow worms?

No Stream or ditch Pond Lake River Canal Sea

Are you aware of any chemicals used on the land?

Definitely not Yes: weedkillers Yes: insecticides Yes: slug pellets Don't know

Is the area grazed?

No Sheep Cattle Horses Rabbits Deer

Is there a slope or open aspect to the site?

No 

Yes: N NE SE SW NW

Artificial lighting:

None Distant lights: over 200m Distant lights: over 50-200m Bright lights nearby House lights only Lights from passing traffic 

Any other comments about the site (e.g. early records of glow worms not previously reported, changes in use of the site either in the past or planned).