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A'N <br />(SLUMIT THIS FORM WITH THE SURVEY RETORT WHEN APPROPRIATE) <br />Zapus hudsonius preblei Injury/lYfortality Documentation <br />Found dead <br />Found severely iujured, euthanized <br />Slightly injured, returned to wild <br />Died during handling <br />Date/Time: <br />Location: <br />Weather Conditions: <br />Approximate Time Trap Set: <br />Time Trap Checked: <br />Field Technician(s) Present: <br />Information: <br />PIT TAG Number: <br />Weight (g): <br />Total Body Length (mm): <br />Tail Length (mm): <br />Hindfoot Length (mm): <br />Ear Length (mm)^ <br />Sex: <br />Reproductive Condition(s): <br />Description of Injury: <br />Details of Probable Reasons for Injury or Mortality: <br />Signature of Technician(s): <br /> <br />Pale 20 of 20