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Bed Bug Inspection Form
Today, a bed bug was found in your classroom or on your belongings. While this does not necessarily
mean that the bed bug was brought to college by you, it is important for the college community and
your home that you inspect your home for signs of bed bugs. Enclosed you will find information about
bed bugs and an identification guide to help you with your inspection. The college requests that you
inspect your home, fill out the form below and return to a Campus Safety Compliance Officer in White
(Building 1), room 1-134A upon your return to the campus.
I have been informed that a bed bug was found on me (or my belongings) at college. I understand that
bed bugs can be very difficult to control and in
the best interest of my family and the college community, I
have read and understand the educational materials provided to me regarding bed bugs. I have:
Carefully checked my family and home for signs of bed bug infestation myself.
Hired a pest management professional to check my family and home for signs of bed bug
infestation. Name of pest control company: ______________________________________
After completing a careful inspection, I certify that to the best of my knowledge:
I, or a pest management professional, found signs of bed bugs in my home and I will take the
following actions to eliminate this infestation:
I, or a pest management professional, did not find any signs of bed bugs in my home at this time.
If I find evidence of bed bugs in the future, I will notify the school immediately and take action
to address the infestation.
I understand that bed bugs can be spread to other homes if they are brought to college in backpacks,
clothing, and other belongings. I understand
that if bed bugs are repeatedly found on me or my
possessions, then the college may take additional actions to protect the college community from bed
bugs.
Signature _____________________________________________ Date __________________________
Pest Management Professional’s Signature __________________________________ Date __________
Revised
12/08/2016
