Pest Control Plant Assessment Form
Assess plant pest symptoms, severity, affected areas, and recommended next steps for the plant.
Plant and Site Information
Plant name or species
*
Location or area of the plant
*
Plant type
*
Indoor
Outdoor
Potted
Garden bed
Greenhouse
Orchard
Nursery
Other
Approximate number of plants affected
*
Pest Assessment and Impact
Pest Symptoms Observed
*
Holes in leaves
Wilting
Sticky residue
Chewed stems
Discoloration
Webbing
Spots
Mold
Leaf curling
Visible insects
Other
Severity Rating
*
1
2
3
4
5
Affected Plant Parts
*
Leaves
Stems
Roots
Flowers
Fruit
Whole plant
Other
Recent Changes or Contributing Conditions
Inspection Notes and Action Plan
Treatment Already Applied
*
None
Removed affected parts
Applied insecticidal soap
Applied neem/oil treatment
Used traps
Other
Inspector Notes or Observations
Submit
Should be Empty: