Organic Farm Pesticide Use EMP Submission Form
Farm Name
Location
Contact Person
Phone Number
Email
Date of Submission
1. Crop & Area Information
Crop
Cultivated Area (hectares)
2. Pesticide Details
Pesticide Name
Active Ingredient
Purpose of Use
Dosage (per hectare)
Application Date
Application Method
3. Environmental Management Plan (EMP) Actions
Preventive Measures Taken
Monitoring & Record Keeping Plan
Training Provided to Workers
4. Additional Information
Additional Notes / Comments