Private Applicator Recordkeeping Resources

This page contains various recordkeeping resources that may be useful for farm and ranch owners. The recordkeeping forms on this page are Microsoft Word documents. We recommend that you download the documents, print them, and fill them in with a pen or pencil.

Pesticide Recordkeeping Resources

Private pesticide applicators must make records of all applications involving restricted-use pesticides (RUPs) within 14 days of an application. In Nebraska, you must maintain these records for at least three years. We highly recommend that you make and maintain records for all your pesticide applications, regardless of whether you are applying RUPs or general-use pesticides (GUPs). In addition, you may find it beneficial to keep records of pesticide product inventories, chemigation injection sites, sprayer calibration, emergency contacts, and custom applicator recordkeeping agreements.

Recordkeeping Forms

Private Applicator Field Record Form (DOCX 38 KB) – Use this form to make records of RUP and GUP applications.

Applicator Master List Record Form (DOCX 16 KB) – Use this form to keep track of all the pesticide applicators working on your establishment, including their certification numbers and product-specific training.

Pesticide Product Master List Record Form (DOCX 17 KB) – Use this form to keep track of all the pesticide products you use.

Chemigation Injection Site Master List Record Form (DOCX 18 KB) – Use this form to keep track of your chemigation injection sites' permitting, safety equipment, and points of entry. Each form accommodates up to two injection sites.

Sprayer Calibration Record Form (DOCX 18 KB) – Use this form to keep track of the settings and parameters you have used when calibrating your spray equipment.

Pesticide Emergency Response Sheet (DOCX 24 KB) – This sheet provides a convenient list of procedures and contacts in case of pesticide emergencies. Add information on a nearby medical facility and your local fire department in the space provided.

RUP Application Recordkeeping Agreement Form (DOCX 21 KB) – If you hire a custom applicator to apply RUPs on your establishment, an informal recordkeeping agreement allows the custom application business to maintain RUP application records on your behalf. Use this form to establish an informal recordkeeping agreement.

Pesticide Agency Contacts

Federal

Federal Pesticide Governance

U.S. Environmental Protection Agency (EPA)
Region 7 Office
11201 Renner Boulevard
Lenexa, KS 66219
913-551-7003

Transporting Pesticides

U.S. Department of Transportation
Federal Highway Administration (FHWA)
Nebraska Division Office
100 Centennial Mall North, Room 220
Lincoln, NE 68508
402-742-8460

Agricultural Aviation

Federal Aviation Administration (FAA)
Flight Standards District Ofiice
3431 Aviation Road, Suite 120
Lincoln, NE 68524
402-475-1738

Occupational Safety

U.S. Department of Labor
Occupational Safety and Health Administration (OSHA)
Omaha Area Office
444 Regency Parkway Drive, Suite 303
Omaha, NE 68114
402-553-0171

State of Nebraska

State Pesticide Governance

Nebraska Department of Agriculture (NDA)
Animal & Plant Health Protection
Pesticide Program
P.O. Box 94787
Lincoln, NE 68509

245 Fallbrook Boulevard, Suite 200
Lincoln, NE 68521
402-471-2351

Bulk Chemical Containment and Loadout; Chemigation

Nebraska Department of Water, Energy, and Environment (NDWEE)
245 Fallbrook Boulevard, Suite 100
Lincoln, NE 68521
402-471-2186

Burn Permits and Pesticide Storage

Nebraska State Fire Marshal
Main Office
246 South 14th Street, Suite 1
Lincoln, NE 68508
402-471-2027

Pesticide Safety Information

University of Nebraska-Lincoln
Nebraska Extension
Pesticide Safety Education Program
377 Plant Sciences Hall
Lincoln, NE 68583
402-472-1632

Worker Protection Standard (WPS) Recordkeeping Resources

The Worker Protection Standard (WPS) is a set of regulations that protects agricultural workers and pesticide handlers from pesticide exposure on the job. The U.S. Environmental Protection Agency (EPA) administers the WPS. You must comply with the WPS if:

  • any pesticide (RUP or GUP) is applied on your establishment for the purpose of producing agricultural plant commodities (except applications to harvested portions of plants); and
  • you employ any workers (e.g., roguers, detasselers, nursery transplanters, fruit pickers, other hand laborers) or pesticide handlers (e.g., mixers, loaders, applicators, flaggers, scouts) on your establishment.

The WPS establishes a number of detailed obligations for agricultural employers, including recordkeeping requirements. For a complete account of WPS obligations, read the full WPS regulatory text, read a digital version of the WPS How to Comply Manual, or contact the Nebraska Department of Agriculture for a physical copy of the How to Comply Manual and other useful WPS resources.

WPS Training for Workers and Handlers

As an agricultural employer, you must provide WPS training annually to all workers and handlers in your employment. WPS training programs must be approved by the EPA and conducted by a certified WPS trainer, a certified and licensed pesticide applicator, or a state-designed educator of pesticide applicators (i.e., an Extension educator). Contact the Nebraska Department of Agriculture for help finding an EPA-approved WPS training program appropriate for your intended audience. Workers must receive worker training, and handlers must receive handler training. You must provide the training in a language the employee understands, in an environment relatively free of distractions. Employees have the right to have any questions they have about the WPS answered. You must possess recorded proof that your employees have received their training.

WPS Worker Training Verification Record Form (DOCX 21 KB) – Use this form to record worker WPS training verification.

WPS Handler Training Verification Record Form (DOCX 21 KB) – Use this form to record handler WPS training verification.

Note: Certified and licensed pesticide applicators are exempt from needing annual WPS handler training.

WPS Hazard Communication

If workers or handlers are on your establishment when a) any pesticide has been applied on the establishment within the past 30 days, or b) a restricted-entry interval (REI) for a pesticide has been in effect on the establishment within the past 30 days, you must display, retain, and make accessible certain information related to the pesticide application and general pesticide safety.

Three items must be displayed, retained, and made accessible to workers and handlers:

  1. a pesticide safety poster with emergency contact information filled in;
  2. the Safety Data Sheets (SDS) for all pesticides applied (or whose REIs have been in effect) within the past 30 days; and
  3. records of all pesticide applications made (or whose REIs have been in effect) within the past 30 days.

The application records for WPS display (item 3 above) must contain the following information:

  • pesticide product name, EPA Reg. No., and active ingredient(s);
  • location and description of treated areas;
  • crop or site treated;
  • date of application;
  • start and finish time of application; and
  • length of the product's restricted-entry interval (REI).

WPS Pesticide Application Record Display Form (DOCX 20 KB) – Use this form to record and display pesticide application information for the purpose of WPS compliance.

In addition to the three display items listed above, if a pesticide is applied that has an REI of more than 48 hours, warning signs must be displayed up to 24 hours before the application and removed or covered within three days of the REI's expiration.

WPS Respirator Compliance

If a pesticide label requires an agricultural pesticide handler to wear a respirator, the agricultural employer must provide the handler with a respirator meeting the requirements of the label. In addition, the employer must ensure the handler has received a medical evaluation, a fit test, and respirator training:

  • Doing physical activity while wearing a respirator can put significant strain on the human body. For this reason, pesticide handlers must receive a medical evaluation before attempting to wear a respirator while handling pesticides. The evaluation, performed by a medical professional, determines whether a person is in good enough health to safely wear a respirator. At the conclusion of the evaluation, the medical professional should provide the handler with a written medical clearance recommendation. The agricultural employer should keep this recommendation on file.
  • Handlers must receive a respirator fit test annually. A fit test ensures that a handler is matched with a respirator that properly fits and seals on his or her face. Without this step, a respirator may be ineffective and expose the handler to unacceptable hazard. A person who administers a fit test does not need any certification but must know how to properly conduct a fit test. For more information, see Fit Testing a Respirator for Pesticide Applications, EC3027.
  • Handlers must receive respirator training annually. This training must cover specific topics, including the proper use and maintenance of respirators.

Agricultural employers must have records of the medical clearance, fit test, and respirator training of each handler in their employment.

WPS Employee Respirator Record Form (DOCX 32 KB) – Use this form to record a handler employee's respirator medical clearance, fit test, and training.

Note: WPS respirator requirements only apply to the use of pesticides whose labels require a respirator be worn. If no such pesticides will be handled, none of the requirements discussed in this section apply.

Fumigation

Applications of fumigants require the most in-depth recordkeeping of any type of pesticide application. There are reasons for this: Fumigants are highly toxic and difficult to control. The applicator must create a detailed fumigation management plan (FMP) before a fumigant application. He or she must closely follow the FMP during the application. Finally, the applicator may need to complete a post-application summary (PAS) after the application.

While licensed private applicators can become certified to handle fumigants by passing additional certification exams, both the NDA and Nebraska Extension PSEP recommend that farmers hire commercial fumigators instead of attempting to fumigate on their own. Fumigant applications are best left to professionals.

If you do choose to apply fumigants on your farm, follow the product's label directions and Applicator's Manual extremely carefully, including FMP and PAS requirements. The NDA offers FMP guidance and sample forms on its website.