USDA-NRCS

Arizona State Office

230 North 1st Avenue, Suite 509

Phoenix, Arizona 85003-1733

CULTURAL RESOURCES WORKSHEET/FIELD INSPECTION RECORD
PART 1: PROJECT INFORMATION
Enter data to the right of each bullet prompt. Attach additional pages as needed.
Table rows will automatically increase in height as new data are entered.
Enter an X in the cell to the right of the appropriate prompt in this row. / Preliminary version: / • / Final (post-survey) version: / •
Form completed by (name):
• / NRCS field office:
• / Preliminary form date: •
Final form date: •
Name(s) of client(s): •
Conservation plan or project name: •
Name of this electronic file (for tracking): •
Cooperators(e.g., Arizona Game and Fish Dept., BLM, USFS, USFWS, conservation district): •
Other federal agencies involved in project landownership, permits/licensing, or funding: •
Land jurisdiction:
Color-highlight the appropriate cell(s) / Private / City, town, or municipality / County / State / Tribal / U.S. Forest Service / U.S. Fish & Wildlife Service
National Park Service / Bureau of Land Mgmt. / Department of Defense / Army Corps of Engineers / Bureau of Reclamation / Resolution Trust Corp. / Other (specify):
•
County: • / USGS 7.5’ quadrangle name(s): •
Attach 1:24,000-scale copy of portion of 7.5’ USGS map(s) showing the APE
Township(s), range(s), section(s) & subdivision(s) to nearest quarter-section
(e.g.,T12S, R16E, Sec 9 NE¼,Sec 25 S½,Sec 36 All ): •
Linear practices only:
Length (specify feet or meters): • / Nonlinear practices only:
Total acres in area of potential effects (APE): •
Anticipated start date of ground disturbance: •
Current land use: •
Provide a narrative description of project without referring to NRCS practice codes. Indicate what actions are planned, what kinds of equipment will be used, project location (include access routes and equipment/vehicle staging areas as part of the APE), and width and depth of any anticipated ground disturbances.
Project description: •
NRCS practice codes: • / NRCS funding source (e.g., EQIP or EWP): •
UTM coordinates (NAD83) for APE perimeter and approximate center; or for end and turn points oflinear APE:Also show on an attached map. / UTM Zone:
• / APE center: •
Perimeter incl. access & staging areas: •
Perimeter(s)of separate access/staging areas: •
Linear APE end and turn points: •
Describe the number, condition, age, and function of all existing utilities and improvement features in the APE, including any structures, canals, etc., to be removed or damaged by NRCS-assisted practice; provide sketch(es) and/or photograph(s) as needed. Utilities and improvements affected: •
Checklist – Enter Yes or No in response to each prompt. / 1:24,000-scale copy of a portion of 7.5’ USGS quadrangle is attached / • / UTM coordinates for project area center and limits are included on map / •
The following part of this form (Part 2)is to be completed only after performing the cultural resources survey.
CULTURAL RESOURCES WORKSHEET/FIELD INSPECTION RECORD
PART 2: CULTURAL RESOURCES SURVEY RESULTS
Complete this section after performing cultural resources survey
Date(s) of survey fieldwork:
• / Personnel who participated in survey:
•
Transect spacing:(Specify whether in meters or feet. Transects must be no farther than 15 m (49.2 ft) apart)
• / Person-field days used:[1]
•
No. of archaeological sites present:[2] • / No. of isolated archaeological features without as-sociated artifacts: • / No. ofother isolated archaeological occurrences: • / No. of photographs:
•
List and describe all sites and isolated archaeological features,and include UTM coordinates. Describe, sketch, and/or photograph all culturally or temporally diagnostic artifacts.
Summary of cultural sites found: •
List and describe each isolated artifact(s) occurrence, and include UTM coordinates. Include sketch(es) and/or photograph(s) for all culturally or temporally diagnostic artifacts.
Isolated artifacts and cultural features: •
Remarks: •
Checklist – Enter Yes or No to the right of each bullet prompt.
Is a 1:24,000-scale or larger copy of a portion of the 7.5’ USGS quadrangle showing all cultural sites, features, and isolatesattached?
• / Are UTM coordinates for all archaeological sites and features shown on the map(s)? • / If photographs were taken, have they or the digital files for them been submitted with the completed form?
• / Has Part 1 of this form been revised as necessary after completing cultural resources survey?
•

[1] Person-field day (PFD) count is the number of calendar days spent in cultural resources fieldwork times the number of persons working each fieldwork day, not counting travel days in which no fieldwork was done. For example, if 2 persons surveyed on 1st day and 3 persons surveyed on 2nd day, total PFD = 5.

[2] A full cultural resources survey report must be prepared by a cultural resources specialist for any survey in which an archaeological site is present in the APE or close enough that site avoidance must be recommended.