Chimney Swift Structure Report

Chimney or Swift Tower Report Form
ChimneySwift TowerOther
Coordinates *
Latitude, Longitude of the sighting
Click here to find coordinates (opens in a new window)
NestingRoostingBoth nesting and roostingTower-not yet used
The chimney is in need of repair
One nesting pairRoost-less than 25Roost-25 to 100Roost-more than 100Unknown
Comments
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Photos really help! Cancelof
Your Information
Name*
E-mail*
Phone Number*
Format: 000-000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Chimney or Tower Owner Information
Same as observerOwner information belowI don't know who the owner is
Property Type*
Property Name
Name of school, factory, other facility
Display on map (towers only)*
Do you give permission to have the tower location displayed on a map?
Public Access (towers only)*
Will you allow the public to view the swifts?
MBCP Access*
Can a trained Chimney Swift Program volunteer observe swifts on the property?
** Skip to SUBMIT if you selected "Same as observer" for the Owner **
Owner Name
Owner Address

Street Address

Street Address Line 2

CityState

Zip Code
Owner Email
example@example.com
Owner Phone
Format: 000-000-0000.
Should be Empty:

Chimney or Swift Tower Report Form