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Download DA Form 8019-R, also known as Rodent Survey. This survey is a part of the United States Army’s pest surveillance program. Rodents carry severe diseases if populations are out of control. A collector will go to each site and observe for the purpose of collecting specimens in order to test for disease, observe traps in search of information regarding infestations in and around dwellings. This form will record information with regard to sanitation, harborage, signs of rodents in and around dumpsters etc.

How To Fill-In

Step 1 – Section 1. Begin by filling in blocks 1 through 6 as follows:

  • 1. Building
  • 2. Organization
  • 3. Date
  • 4. Time
  • 5. Person Contacted
  • 6. Survey Officer

Step 2 – Part 1. Building Interior – Section A – Sanitation – Complete blocks 7 through 12:

  • 7. Sanitary Conditions (check the box that applies)
  • 8. Spilled Food (check yes or no)
  • 9. Rodent Proof Containers (check yes or no)
  • 10. Damaged Food Containters (check yes or no)
  • 11. Plumbing Leaks and Condensation (check yes or no)
  • 12. Other (describe other conditions observed)

Step 3 – Part 1. – Section B – Harborage – Complete blocks 13 through 18:

  • 13. Harborage Conditions (check appropriate box)
  • 14. Accumulated Debris (check yes or no)
  • 15. Material Stored Next To Wall (check yes or no)
  • 16. Holes In Walls (check yes or no)
  • 17. Enlarged Holes Around Pipes and Doors (check yes or no)
  • 18. Other (enter other observations)

Step 4 – Part 1. – Section C – Rodent Signs – Complete blocks 19 through 26:

  • 19. Kind (check mice, rats or both)
  • 20. Dead/Live Rodents (check yes or no)
  • 21. Tracks/Trails/Rub Marks (check yes or no)
  • 22. Droppings/Urine (check yes or no)
  • 23. Nests (check yes or no)
  • 24. Odors (check yes or no)
  • 25. Gnawing (check yes or no)
  • 26. Other (enter other observations )

Step 5 – Part 2. Building Exterior – Section A – Dumpsters/Refuse Containers – Complete blocks 28 through 32:

  • 28. General Conditions (check appropriate box)
  • 29. Food Water Availability (check appropriate box)
  • 30. Dirty (check yes or no)
  • 31. Drain Plugs Missing (check yes or no)
  • 32. Lids (check all that apply)

Step 6 – Part 2. – Section B – Harborage – Complete blocks 33 through 37:

  • 33. Harborage Conditions (check the one that applies)
  • 34. Stored Materials (check yes or no)
  • 35. Rubbish/Trash/ Junk (check yes or no)
  • 36. Tall Grass/Weeds (check yes or no)
  • 37. Shrubs/Leaves/Vines (check yes or no)

Step 7 – Part 2. – Section C – Rodent Access – Complete blocks 38 through 42, check all that apply and make necessary entries:

  • 38. – Gap (1/4 in or more) Under Doors – (check yes or no)
  • 39. – Doors Left Open (check yes or no)
  • 40. – Enter (any other necessary observations)
  • 41. – No Screening (check all that apply)
  • 42. – Enlarged Holes Around (check all that apply)

Step 8 – Part 2. – Section D – Rodent Signs – Complete blocks 43 through 51:

  • 43. – Kind (check mice, rats or both)
  • 44. – Dead/Live Rodents (check yes or no)
  • 45.  Tracks/Trails/Rub Marks (check yes or no)
  • 46. – Droppings/Urine (check yes or no)
  • 47. – Nests (check yes or no)
  • 48. – Burrows (check yes or no)
  • 49. – Gnawing (check yes or no)
  • 50. – Other (enter any other important observations)
  • 51. – Remarks (enter any important remarks with regard to observations)

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