Agricultural Pesticide Use Risk Assessment Form
General Information
Assessor Name
Date
Location / Field
Crops Involved
Pesticide Details
Pesticide Name
Active Ingredient(s)
Pesticide Type (e.g. herbicide, insecticide, fungicide)
Application Rate
Application Method
Risk Assessment
Potential Environmental Hazards
Potential Human Health Hazards
Risk Management Measures and PPE Required
Emergency Procedures
Assessment Outcome
Overall Risk Level
Low
Medium
High
Additional Comments / Recommendations