Private Applicator Recordkeeping Resources

These forms are designed to be filled out on a computer using Adobe Acrobat.

Applicator Master List (PDF 113 KB) – Keep track of all the applicators working on your establishment, including their certification numbers and product-specific training.

Pesticide Product Master List (PDF 90 KB) – Keep track of all the pesticide products you use. This form can serve as a convenient reference when recalling a product's EPA registration number, active ingredient, concentration, or use classification.

Chemigation Injection Site Master List (PDF 96 KB) – Keep track of your chemigation injection sites' permitting, safety equipment, and points of entry. Each form accomodates two injection sites.

Private Applicator's Field Record (PDF 206 KB) – Pesticide applications (including tank mixes, resistance management, and sprayer setup) are just part of what this form can track. Record a field's soil information, nutrient analyses, fertilizer applications, and irrigation, too. Use one form for each field.

WPS Training Verification Record (PDF 92 KB) – All agricultural workers and pesticide handlers must receive Worker Protection Standard (WPS) training annually. As an agricultural employer, you must have recorded proof that your employees have received their training. This form can record both work and handler training verification.

WPS Respirator Record (PDF 94 KB) – Some agricultural pesticide require their handlers to wear respiratory protection. When this is the case, handlers must follow several steps to comply with the WPS: 1) be medically evaluated to determine if they are fit to wear a respirator while working; 2) be fit tested for the respirator they will wear when handling the pesticide; and 3) be trained on various aspects of using a respirator. This form provides an easy wa to track an employee's fulfillment of these requirements.

WPS Hazard Communication Record (PDF 59 KB) – When workers are expected to be on your farm within 30 days of any pesticide application, the WPS requires you to display information about the pesticide application in a central, easily-accessible location on your establishment. This form can serve the purpose.

Sprayer Calibration Record (PDF 62 KB) – The importance of sprayer calibration is difficult to overstate. This form makes it easy to keep track of the settings and parameters you've used when calibrating and recalibrating.

Recordkeeping Agreement (PDF 39 KB) – If you hire a custom applicator, an informal recordkeeping agreement allows the custom application business to maintain application records for you. This form can be used for just such an agreement.

1. Click on the form you want to use. This will open it in your web browser.
2. Once the form is open in your browser, click 'Download' to save the file to your computer.
3. Open the file in Adobe Acrobat.
4. Once the file is open, select 'Fill & Sign.'
5. To fill in text fields, click on a field to select it. Once the field is selected, type to fill it with text.
6. To fill in date fields, click on a field to select it. An arrow should appear next to the field. Click the arrow to access a dropdown calendar. select the desired date from the calendar to fill in the field.
7. To fill in checkbox-type fields, simply click on a field to mark it.
8. When a signature is needed (e.g., WPS training records), do the following:
   1. On the 'Fill & Sign' toolbar at the top of the window, click the 'Sign' button, then click 'Add Signature.'
   2. Adobe will give you the option to type, draw, or add an image of a signature. We recommend typing. Type your name and select a font style.
   3. When you are satisfied with the apearance of your signature, click 'Apply.'
   4. Repeat these steps for multiple signatures.
   5. NOTE ON SIGNATURES 1: When filling forms that require signatures, do not click 'Save' until you are sure the form is completely filled out. Once you add one or more signatures and click 'Save,' you will no longer be able to add information to the form.
   6. NOTE ON SIGNATURES 2: You cannot legally add someone else's signature to a form for them. For example, this means that if you have 10 agricultural workers who need WPS training, each worker must personally sign the WPS Training Verification Record. As an alternative to having each person sign using the computer, you may fill in their names and training dates digitally (leaving the signature column blank) and then print the form. Each person can then physically sign the form with a pen.
9. When you have finished filling out a form, click 'Save.'
10. File your records electronically, as printed documents, or both.