Agricultural Worker Sighting Report Form
Please provide details about your sighting of agricultural workers. Accurate and complete information helps ensure effective follow-up.
Date of Sighting
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Sighting
Hour Minutes
AM
PM
AM/PM Option
Location of Sighting
*
Type of Location
Please Select
Farm
Field
Orchard
Greenhouse
Packing Facility
Other
Number of Workers Observed
Type of Activity Observed
Planting
Harvesting
Irrigation
Packing
Operating Machinery
Other
Description of Sighting
*
Your Name
First Name
Last Name
Your Email
example@example.com
Your Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit Report
Should be Empty: