Pesticide Application Record Sheet

Date of Application

Time of Application

Applicator Name

Field/Location

Crop

Area Treated (ha/acres)

Pesticide Brand Name

Active Ingredient

EPA Registration No.

Rate of Application

Dilution (if any)

Method of Application

Weather Conditions

Wind Direction/Speed

Personal Protective Equipment Used

Target Pest(s)

Re-Entry Interval

Pre-Harvest Interval

Remarks/Notes