Form PPQ Form 377 PPQ Form 377 Gypsy Moth Checklist and Record of Your Self-Inspection

day, if possible. If you cannot complete the inspection
on moving day, you must protect the items from the
possibility of infestation by sealing them under a tarp,
keeping them indoors, or in a closed moving truck.
For self-inspection, follow these steps:
• Carefully inspect all surfaces and crevices of your
outdoor household articles such as patio furniture, lawn
equipment, toys, grills, trailers, and vehicles for gypsy
moth egg masses.

•

Remove and destroy any egg masses you find. Scrape
them off with a putty knife, stiff brush, or similar hand
tool. Dispose of egg masses and other life stages in a
container of hot, soapy water, or place them in a plastic
bag, seal it, and set it in the sun.

•

Check each item off on your checklist as you go, and
complete the requested information.

MAS
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WHAT
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OOK FOR
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IT’S THE LAW: BEFORE MOVING,
CHECK FOR THE GYPSY MOTH

If a qualified, certified applicator performs the inspection, be
sure you get a copy of the completed, signed checklist.

2) During your move, keep a copy of the completed checklist in
the vehicle moving the goods in case a U.S. Department of
Agriculture (USDA) or State official requests it at any point
during your trip. If you are not driving, provide a copy to
the driver. This completed checklist is an official certificate
that will satisfy the requirements of all
non-infested States.

What Does the Law Require?
If you are moving from a gypsy moth quarantine area to a
non-quarantine area, you must inspect your outdoor household items for the gypsy moth and remove all life stages of
this destructive insect before you move. You may face
penalties if you are required to inspect but fail to do so.
Fortunately, this inspection is easy to do, and you will protect
your new neighborhood from a voracious leaf eater that can
attack over 300 kinds of trees and shrubs.

How Do I Know if I Live in a Gypsy Moth
Quarantine Area?
Visit www.YourMoveGypsyMothFree.com and click on the
U.S. map to find out if you live in a quarantine area. If you
do, you will need to inspect your household goods for gypsy
moth if you’re moving to a non-quarantine area. If you do not
live in a quarantine area, this law does not apply to you.

I Live in a Quarantine Area and Am Moving to a
Non-Quarantine Area. How Do I Meet This
Legal Requirement?
1)

Use the self-inspection checklist on the back of this flyer

3) Once your move is completed, you may want to keep the

checklist filed with your moving materials in case you need
it in the future.

Where Do I Go For Help?
• See the back of this flyer for photos of all gypsy moth
life stages.

•

Learn more at www.YourMoveGypsyMothFree.com.

•

Contact your State Department of Agriculture or nearest
USDA Animal and Plant Health Inspection Service (APHIS)
office (www.aphis.usda.gov/planthealth/sphd).
USDA is an equal opportunity provider, employer, and lender.
This publication supersedes Program Aid No. 2065,
“Your Next Move Gypsy Moth-Free,”
which was published in October 2010.
Issued October 2013
Revised September 2018

Animal and Plant Health Inspection Service
Program Aid No. 2147

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0104. The time required to complete this
information collection is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE
1. Originating Property Address

OMB APPROVED
0579-0104
EXP. DATE
XX/XX/20XX

GYPSY MOTH CHECKLIST AND
RECORD OF YOUR SELF-INSPECTION

Important: Make sure this checklist goes with your outdoor household items when you move
2. Date

3. Recreational or Camping Items
Backpacks

Ice Chests

Basketball Backboards

Motorcycles

Tarps
Tents

Bicycles

Motor Homes

Waders or Boots

Boats

Recreational Vehicles

Other: _____________________

Boat Trailers

Snowmobiles

None

Campers

Sports Equipment

Gypsy moth egg masses on a lawn mower
(USDA/APHIS, Susan Lane)

4. Household Items
Air Conditioners

Ladders

Tanks for Propane and Oil

Barrels

Outdoor Doormats

Television Antennas

Cardboard and Wooden Boxes

Outdoor Thermometers

Trash Cans

Clothesline Poles

Refrigerators

Washing Machines

Clothespin Bags

Sheets of Plastic

Water Hoses

Empty Plant Containers

Shutters

Weather Vanes

Firewood*

Storage Sheds

Window Awnings

House Plants (taken outside
during the summer)

Storm/screen Doors and Windows

Other: _____________________

Gypsy moth egg mass on a padlock
(USDA/APHIS, Susan Lane)

None

5. Building Materials
Bricks

Roofing Materials

Welding Equipment

Cement Mixing Tubs

Sewer Pipes

Workbenches

Cinder Blocks

Tools and Toolboxes

Other: _____________________

Lumber

Water Pipes

None

6. Yard and Garden Items
Animal Houses (doghouses,
rabbit hutches, etc.)
Barbecue Grills

Fertilizer Spreaders

Storage Sheds

Flagpoles

Swimming Pools

Birdbaths

Garden Tillers

Tractors and Trailers

Bird Feeders

Garden Tools

Trees, Shrubs, and Plants

Bird Houses

Lawnmowers

Trellises

Bug lights

Mailboxes

Wheelbarrows

Carts

Picnic Tables

Yard Decorations

Cold Frames

Porch or Patio Furniture

Other: _____________________

Driftwood

Signs and Posts

None

Fencing

Snow-blowers

Gypsy moth caterpillar (larva)
(Daniel Herms, The Ohio State University,
Bugwood.org)

Gypsy moth pupae
(Pennsylvania Department of Conservation
and Natural Resources, Forestry Archive,
Bugwood.org)

7. Children’s Playthings
Swing sets

Other Outside Toys (like trucks or
sand molds)

Playhouses

Tire Swings

Other: _____________________

Sandboxes

Wagons

None

Cars or Trucks

Farm Implements

None

Car Parts

Stored Tires (snow tires)

Car Ramps

Other: _____________________

Bicycles, tricycles

Sleds, Toboggans
8. Other Items
Female (top) and male adult gypsy moths
(USDA APHIS PPQ Archive,
USDA/APHIS/PPQ, Bugwood.org)

Inspect anything that was stored outside
By signing my name in block 9 below, I agree that I am legally signing this document and affirming that I have inspected all outdoor household articles, whether included on
this checklist or not, for all life stages of gypsy moth in accordance with the procedures on this form, as required by Title 7, Code of Federal Regulations, Part 301.45-4(a).
9. Signature and Date
10. Phone Number

11. Printed Name

12. Company Name (if applicable)

* To avoid spreading other tree pests, move only USDA- or State-certified, treated, and labeled firewood.
PPQ Form 377
SEP 2018

Note: The electronic signature function on this form works only if the user opens the file in Internet
Explorer or Adobe Acrobat.