Welcome to our collection of private pesticide applicator recordkeeping resources. Here you will find printable record forms and digitally-fillable record forms, plus supplementary information to help you make safe and effective pesticide applications.
Private applicators are required to make records of all applications involving restricted use pesticides (RUPs). These records must be maintained for at least three years. While not required, it is highly recommended that you make and maintain records for all your pesticide applications, regardless of whether the products you are using are RUPs or general use pesticides (GUPs).
Standard printable record forms
These PDF documents can be printed and filled in by hand. Download the files and print as many copies as you need, or return to this site to print more as needed.
Applicator Master List (PDF 66 KB) – Keep track of all the applicators working on your establishment, including their certification numbers and product-specific training.
Pesticide Product Master List (PDF 57 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 62 KB) – Keep track of your chemigation injection sites' permitting, safety equipment, and points of entry. Each form accommodates two injection sites.
Private Applicator's Field Record (PDF 106 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 65 KB) – All agricultural workers and handlers must receive Worker Protection Standard (WPS) training. As an agricultural employer, you must have recorded proof that your workers and handlers have received their training. This form can record both worker and handler training verification.
WPS Respirator Record (PDF 66 KB) – Some agricultural pesticides 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 resiprator 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 way to track an employee's fulfillment of these requirements.
WPS Hazard Communication Record (PDF 52 KB) – When workers are expected to be on your farm within 30 days of a pesticide application (RUP or GUP), 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 56 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 41 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.
Digitally fillable record forms
These forms are designed to be filled out on a computer using Adobe Acrobat. Descriptions of each form can be found above. Instructions for using the digitally-fillable forms can be found in the dropdown menu below.
Instructions for using digitally-fillable forms
- Click on the form you want to use. This will open it in your browser.
- Once the form is open in your browser, click
Downloadto save the form to your computer.
- Open the file in Adobe Acrobat.
- Once the file is open, select
Fill & Sign.
- For text fields, click on a field to select it. Once the field is selected, type to fill it with text.
- For 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.
- For checkbox-type fields, simply click on a field to mark it.
- When a signature is needed, do the following:
- On the
Fill & Signtoolbar at the top of the window, click the
Signbutton, then click
- 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.
- When you are satisfied with the appearance of your signature, click
- Repeat these steps for multiple signatures
- Please note: When filling forms that require signatures, such as the WPS Training Verification Record, do not click
Saveuntil 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.
- Another note on signatures: You cannot legally add someone else's signature to a form for them. 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 with 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.
- On the
- When you have finished filling out a form, click
- File your records electronically, as printed documents, or both.
Applicator Master List (PDF 113 KB)
Pesticide Product Master List (PDF 90 KB)
Chemigation Injection Site Master List (PDF 96 KB)
Private Applicator's Field Record (PDF 206 KB)
WPS Training Verification Record (PDF 92 KB)
WPS Respirator Record (PDF 94 KB)
WPS Hazard Communication Record (PDF 59 KB)
Sprayer Calibration Record (PDF 62 KB)
Recordkeeping Agreement (PDF 39 KB)
Supplemental information sheets
Pesticide Emergency Response (PDF 65 KB)
Pesticide Agency Contact List (PDF 67 KB)
Calibration Cheat Sheet (PDF 77 KB)
WPS General Compliance (PDF 70 KB)
WPS Respirator Compliance (PDF 66 KB)
WPS Hazard Communication Compliance (PDF 69 KB)
Applications of fumigants require the most in-depth recordkeeping of any type of pesticide application—for good reason. Fumigants are difficult to control and are highly toxic. For these reasons, a fumigation management plan (FMP) must be created before an application. The FMP must then be closely followed during the application. Additionally, a post-application summary (PAS) must be completed after the application.
While a private applicator license allows the licensee to use fumigants, both 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 and PAS requirements. NDA offers FMP guidance and sample forms on its website.