View Full Version : pesticde application records
01-23-2005, 02:45 PM
I was just wondering if anyone knew where I could find a sample pesticide application record. I am looking for ideas on one that will work for me thanks
01-24-2005, 01:45 PM
It would be nice to see how everyone is keeping records.
Below is mine that I modified to show here. This would be for my first application which I list below. I leave this at the customers door in plastic flyer bag same time I am doing the application and I also fill out another sheet to keep as my records.
I change the Lesco products I am using for each visit on the sheet and I also add on any spraying chemicals i used for a particular visit. This is what i have found I need for record-keeping for the State of Missouri. I started fert/spray middle of last year so some better way of doing it.
I keep a Word document that has everything I use for the year for all the rounds (i.e. fert/spray) and then for each round I create another Word document that shows what I will use for that round. I would have the fert for one line below and then the spray chemicals on another line. I then check off which one I used for each yard for the round.
Anyone see ways to improve on this let me know.
?city, state zip?
Home – xxx-xxx-xxxx
Cell - xxx-xxx-xxxx
Customer Name: ________________________
Service Provided: ________________________
____ Lesco 19-0-6 slow release / 0.10% Dimension / EPA # 10404-85 /
4.13 lbs. pr 1,000 sq. ft.
____ Speedzone Southern / EPA # 2217-835 /
1.5 – 2.2 fl. oz. per 1,000 sq. ft.
Note to Customer
Date Completed: ______________ Time: _______ AM PM
Applicators Name: ______________ License # ________
Sq. Ft. Treated: ______________
Wind Direction: N W S E
Wind Speed: 0 – 5 6 – 10 11- 15
01-24-2005, 05:01 PM
you must also include the type of spray/spreader it was applied with.
01-24-2005, 06:07 PM
Here are the laws for Kansas --
Page 9 of 34
2-2455. Written statement for services to customer; records, maintenance and availability to secretary. (a) Each
pesticide business shall present to each customer for whom such business performs a pest control service involving the
application of pesticides a written statement of services or contract setting forth the following information:
(1) Business name and address of the pesticide business licensee;
(2) name and address of the customer;
(3) pest or pests to be controlled, which may be stated in general terms;
(4)pesticide to be used including the quantity applied and total area to which the pesticide is applied
(5) the concentration or rate of application, when applicable;
(6) the date and location of the application of the pesticide;
(7) the expiration date of all guarantees, if any be given;
(8) the signature of the individual who performed or supervised the performance of the pest control service or
the application of pesticides;
(9) the wind direction and velocity, when applicable; and
(10) that the application was less than label rate, when applicable.
(b) Whenever the service involving the application of pesticides is performed for the purpose of controlling
termites, powder-post beetles, wood borers, wood-rot fungus or any other wood destroying pest, the following information
shall be included in addition to that required under subsection (a): (1) The conditions under which retreatments, if any
are to be made;
(2) the approximate date or dates of inspections, for any to be made after the original application of the pesticide;
(3) a diagram of the structure to be treated, showing the location of visible evidence of active and inactive
infestations by any wood destroying pest or pests for which the treatment is proposed; where a partial or spot treatment
is to be made, this diagram shall also show the area or areas of the structure which are to be treated.
(c) The required written statement of services or contract for services involving the application of pesticides may
be incorporated into any business form used by the pesticide business licensee. The written statement of services or
contract shall be presented to the customer at a time established by rules and regulations promulgated by the secretary or
board. Any pesticide business licensee using aerial methods of applying pesticides may present such information at any
time prior to the time payment is accepted. The pesticide business licensee shall retain a copy of each written statement
of services or contract in such licensee's files for a period of three years from the expiration date of any written statement
of services or contract. Each pesticide business licensee shall faithfully carry out the stipulations set forth in any written
statement of services or contract prepared by such licensee or any of its representatives.
(d) Each pesticide business licensee shall make available to the secretary upon request, a copy of any written
statement of services or contract, records of all pesticide applications during any specified period, records of all employees
who performed any service involving, or in conjunction with, the application of pesticides and any other requested
information pertinent to the administration of this act or any rule or regulation adopted hereunder by the board.
(e) The secretary shall require certified commercial applicators who are not employed by or otherwise acting for
a business licensee to maintain records concerning applications of restricted use pesticides. The secretary shall specify by rules and regulations the information to be contained in such records, which shall be maintained for three years from the date of application of the pesticide concerned. Such records shall be open to inspection by the secretary or the secretary's authorized representative during normal business hours, and copies shall be furnished to the secretary or the inspector with no notice.
I highlighted all of the things I didn't see on your form -- but maybe they were there. I didn't start keeping copies of all statments until last year. Had to move to carbonless forms.
01-24-2005, 09:09 PM
In NJ: ".......type of spray/spreader it was applied with."
In KS: all of hammons post!
And my report specs from IN would be of no help to you in MN. It depends on your own state requirements. Suggest you check with your own state regulatory office to get specs for your state. When IN changed the specs for us 3-4 years ago, they actually gave us a sample form that would fit the new requirements.
If you take ideas from guye from otehr states, you may be setting yourself up for trouble with your state regulators.
01-24-2005, 09:17 PM
i was replying specifically to DSL who IS from KS!
i was replying specifically to DSL who IS from KS!
I am on the Missouri side of the state line.
Hey Hamons thanks for posting Kansas laws. It made me double check my document for Missouri laws.
I have the Customer name on it but forgot to add more lines for the address.
Yes I have a line for pests to control where I write it in but deleted it from my example since I didn't show the product I would use for pest control on my example.
I also have a line called "Applicators name" for my signature shown on the example.
Yes I keep a copy of the what I give to the customer as an audit trail if Missouri wants to audit my records.
Also in the "Notes to Customer" of my document when I spot spray I will say "spot spray - treated for noxious weeds". This is all that is needed according to Missouri extension publication 692.
See Missouri extension publication 692 for federal requirements and for Missouri requirements see MU Guide "Pesticide laws and Regulations" publication G 855.
I hope this helps someone but my example is only what I use in Missouri for ROUND 1 ONLY and every state has different requirements. (i.e. Missouri doesn't require you to list what you used to apply the fertilizer/ chemicals.)
If anyone from Missouri noticed I missed something let me know.
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