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Download DA Form 8017-R, also known as the Tick Survey Data/Carbon Dioxide Trap Data. This is part of the United States Army’s pest surveillance program. This form will collect data with regard to the surveillance of various species of ticks. Ticks are capable of spreading severe and even deadly results once they attach to their chosen host. The most commonly used trap is the Carbon Dioxide trap. Since ticks are drawn to carbon dioxide which is vaporized from dry ice, dry ice is placed onto a white cloth where the ticks can be easily removed if needed. If they must be trapped in the field over night, double sided sticky tape may be used so that they will remain where they are until the collector returns to collect data.

How To Fill-In

Step 1 – Fill in blocks 1 and 2:

  • Date (yyyy/mm/dd format)
  • Collector (full name)

Step 2 – Section 3. – Weather Data- Complete a., b., and c. in this section, as follows:

  • a. Temperature
  • b. Wind Speed
  • c. Cloud Cover

Step 3 – Section 4 – Fill in blocks 4 and 5 as required:

  • 4. Site Number
  • 5. Grid

Step 4 – Section 6 – Trap- Enter all information required in blocks 7,8,9 and 10 as follows:

  • 7. Time
  • a. Start
  • b. End
  • 8. Number
  • a. Larvae
  • b. Nymphs
  • c. Adults
  • 9. Index

Step 5 – Average number of ticks (three traps) Divided by time in hours

Step 6 – Specimens sent to USAEHA for ID

Step 7 – Enter required information into blocks 11,12 and 13:

11.Date (yyyy/mm/dd format)

12. Species (of ticks collected and studied)

13. Comments ( any observations that could be important to this surveillance)