2017 Final Report Form

Mosquito Control Grant Program

Organization Name / Click or tap here to enter text.
Contact Person / Click or tap here to enter text.
Contact Phone / Click or tap here to enter text.
Contact Email / Click or tap here to enter text.
Request Date / Click or tap to enter a date.
Final Report Due Date / Click or tap to enter a date.
Award Amount / Click or tap here to enter text.
  1. In addition to completing this Final Report form, please attach all receipts and invoices for purchases/activities made using MCG monies and all approvals for revised budgets or project period extensions.
  1. In Table A, please input the amount of monies awarded for each Fundable Activity in the Monies Awardedcolumn. If a Revised Budget Proposal was submitted and approved, input the amount of monies approved for the revised budget per Fundable Activity in the Monies Awarded column.

Input only the amount of actual grant monies expendedfor each Fundable Activity in the Monies Expended column.

The Monies Awarded column should never exceed the Monies Expended column. If Monies Expended is less than Monies Awarded, ensure unspent funds are reimbursed to the state (see MCG Contract).

Table A: 2017 MCG Expenditures
FUNDABLE ACTIVITIES / MONIES AWARDED / MONIES EXPENDED
1.Mosquito Surveillance
2. Larval Control
3. Adult Control
4. Community Outreach & Education
5. Source Reduction
6. Seasonal Employee(s)
7. Contracted Services
8. Monies Rounded
TOTALS

Note: Fundable Activity 8: Monies Rounded refers to the rounded dollar amount awarded above the original funding request.

  1. Please complete the table below:

Y / N
  1. Was a contract extension requested?

  1. If yes, was a contract extension approved?

  1. If yes, is the Contract Extension Approval attached to this form?

  1. Was a revised budget requested?

  1. If yes, was a revised budget approved?

  1. If yes, is the Revised Budget Approval attached to this form?

  1. Were all MCG monies expended at the time this final report was submitted?

  1. If no, please enter the amount of unspent MCG monies: $

  1. If no, have remaining monies been reimbursed to the state?

  1. Were all invoices and/or receipts from purchases made using MCG monies attached to this form?

  1. Please complete the following tables with all applicable information as it relates ONLY to the expenditure of grant monies. Only complete the sections and input information for programs that were partially or fully funded through the mosquito control grant. Include total values and provide additional information in “Other” as needed:

SURVEILLANCE SUMMARY DATA
# of traps set for collection: / # of mosquitoes collected for testing:
Aedes aegypti identified: Y N / Aedes albopictus identified: Y N
Samples sent to ODH lab: Y N / Disease detected: Y N Specify:
Fuel costs: / Mileage:
Data used to target control activities: Y N / GIS used to map activities: Y N
Equipment purchased: Y N Specify:
Other: Click or tap here to enter text.
LARVAL CONTROL SUMMARY DATA
# of granules, pellets, tablets, dunks purchased:
# of granules, pellets, tablets, dunks used:
Surveillance used to target larval control: Y N / GIS used to map activities: Y N
Equipment purchased: Y N Specify:
Other: Click or tap here to enter text.
ADULT CONTROL SUMMARY DATA
Adulticides purchased: Y N / Quantity of adulticides purchased:
Adulticides used: Y N / Quantity of adulticides used:
# of adult control activities conducted:
Surveillance used to target adult control: Y N / GIS used to map activities: Y N
Equipment purchased: Y N Specify:
Other: Click or tap here to enter text.
COMMUNITY OUTREACH AND EDUCATION SUMMARY DATA
Educational materials (brochures, pamphlets, etc.): Y N / Quantity:
Billboards: Y N / Quantity:
Doorhangers: Y N / Quantity:
Bug repellent (for community distribution): Y N / Quantity:
Dunks (for community distribution): Y N / Quantity:
T.V. adds: Y N / Quantity:
Radio broadcast: Y N / Quantity:
Newspaper adds: Y N / Quantity:
Surveillance used to target outreach: Y N / GIS used to map activities: Y N
Other: Click or tap here to enter text.
SOURCE REDUCTION SUMMARY DATA
Scrap tires collected: Y N / Quantity:
Scrap tire amnesty events: Y N / Quantity:
Illegal scrap tire dumps abated: Y N / Quantity:
Solid waste collected: Y N / Quantity:
Spring cleanup events: Y N / Quantity:
Surveillance used to target source reduction: Y N / GIS used to map activities: Y N
Other: Click or tap here to enter text.
SEASONAL STAFF SUMMARY DATA
# of employees hired: / Timeframe:
# of hours worked: / Hourly rate:
Hours per activity
  1. Surveillance:

  1. Larval control:

  1. Community outreach:

  1. Source reduction:

  1. Other:

CONTRACTED SERVICES SUMMARY DATA
Services provided (if surveillance, complete surveillance table):
Other:Click or tap here to enter text.
MONIES ROUNDED DATA
Please describe what was purchased with any monies awarded over the requested dollar amount (monies rounded up):
Click or tap here to enter text.

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  1. Please describe how grant monies were used to establish new or enhance existing mosquito control programs.
  1. Please provide any recommendations for improving Ohio EPA’s Mosquito Control Grant Program.
  1. Describe any barriers that were encountered when implementing mosquito control activities with Ohio EPA MCG monies.
  1. Describe how the programs established or enhanced with MCG monies will be sustained in subsequent mosquito seasons.

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