| Farmer's name: |
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| Is the crop uniform? (Yes/No) |
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| If not, what percent of the crop area is affected? |
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| General crop observations: |
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| Crop rotation? |
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| Variety planted and growth duration? |
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| Date planted? |
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| Crop stage? |
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| How planted (and seed rate or transplanting pattern used)? |
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| Seed source (own, certified, etc.)? |
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| Is land preparation adequate? |
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| Is the field level? |
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| Are there missing plants? |
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| Are plants lodged? |
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| Are there enough green leaves? |
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| Is groundcover adequate for the crop stage? |
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| Are there differences in crop maturity/stage? |
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| Are there differences in plant height? |
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| Are pests or weeds apparent? |
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| Soil moisture (wet, dry, too wet, too dry)? |
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| In problem areas, what are the symptoms? |
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| Is there a field pattern to the damage? |
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| Plant part affected? (Root, stem, leaves, ear, whole plant) |
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| Draw affected plant part(s) and describe symptom(s) |
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| Where on the plant part is the symptom? |
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| Plant color |
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| Spot or lesion? |
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| Shape & color? |
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| Deformed? |
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| Damaged? |
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| Inputs |
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| Land preparation & leveling how, when |
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| Nutrient management how, when |
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| Insect management how, when |
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| Water management how, when |
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| Weed management - how, when |
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| Disease management - how, when |
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| Suspected priority problems |
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| Has the farmer noted anything different this season? |
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| Highest regional yields |
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| Farmers expected yield |
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| Credit, Labor and input availability |
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| Significance of wheat in household economy |
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| What does the farmer see as the biggest problem? |
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| Other? |
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