Pesticide Application Record (Details as required by regulation) Checklist
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Application Information
Basic details about the application event.
Date of Application
Time of Application (Start)
GPS Coordinates of Application Site
Area Treated (e.g., Acres, Hectares)
Application Method
If 'Other' Application Method, Please Specify:
Description of Application Location (e.g., Field Name, Section)
Applicator Information
Details regarding the person(s) applying the pesticide. Crucial for traceability and certification.
Applicator Name (First Name)
Applicator Name (Last Name)
Applicator License/Certification Number
License/Certification Expiration Date
Applicator Hours of Training (if applicable)
Applicator Employee Status
Applicator Signature
Pest & Crop Information
Details concerning the pest being targeted and the crop being treated. Essential for proper selection and application.
Crop Type
Crop Variety/Cultivar (if known)
Crop Growth Stage (e.g., V4, R2, BBCH scale)
Detailed Description of Crop Condition (health, vigor, etc.)
Target Pest(s) (Primary)
Detailed Description of Pest Identification & Infestation Level
Area Treated (acres or hectares)
Notes regarding pest pressure or infestation history
Pesticide Product Information
Specific details about the pesticide product used in the application.
Pesticide Product Name (as listed on label)
EPA Registration Number
Amount of Product Applied (Units)
Concentration of Product Used (%)
Formulation Type (e.g., EC, WP, GR)
Any Dilution Instructions Followed (Record specifics)
Upload Product Label (if required by regulation)
Application Details
Specifics about how the pesticide was applied – method, equipment, rates, timing, etc.
Application Date
Application Start Time
Application Rate (Pounds per Acre/Hectare)
Amount of Pesticide Applied (Gallons/Liters)
Application Method
Nozzle Type (If Applicable)
Equipment Used (Detailed Description)
Spray Volume (GPA/GPM or L/ha)
Application Equipment Calibration Status
Environmental Conditions
Weather and environmental factors at the time of application. Critical for efficacy and risk mitigation.
Date of Application
Time of Application (Start)
Air Temperature (°C/°F)
Wind Speed (km/h or mph)
Wind Direction
Sky Condition
Soil Moisture (Visual Estimate)
Additional Environmental Notes (e.g., precipitation forecasts, unusually humid conditions)
Buffer Zones & Restrictions
Documentation of adherence to buffer zones and any specific application restrictions.
Were buffer zones implemented?
Buffer zone width (feet) – Water bodies
Buffer zone width (feet) – Sensitive Areas (e.g., residential, organic farms)
Were any local restrictions applied?
Describe any local restrictions applied (if applicable)
Was a Drift Reduction Technology Used?
Describe Drift Reduction Technology used (if applicable)
Was a No-Spray Period Observed?
Record Keeping & Notifications
Details related to record storage, reporting requirements, and any necessary notifications.
Record Creation Date
Record Keeper Name
Notes/Comments (e.g., deviations from label, observations)
Record Retention Method
Record Retention Period (Years)
Notification Required (e.g., water body proximity)?
Details of any Notifications Sent (Recipient, Date, Method)
Supporting Documentation (e.g., maps, label copies)
Record Keeper Signature
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