Page 164 - AG 7-2011 Revised 2016

SAMPLE PESTICIDE TRAINING RECORD DOCUMENT—

Used to acknowledge training has been received in these areas.

PEST CONTROL OPERATOR CHECK OFF

_______ 1. I understand that I am to use only pest control equipment which is in good repair, and safe to
INITIAL operate.
_______ 2. I know that I must have a complete copy of the registered label for the pesticide being used and
INITIAL that it must be available at the use site.
_______ 3. I know that a pesticide container must at all times either have the full label on it or at least a
INITIAL service container label which states name and address of the person or firm responsible for the

container, the identity of the pesticide, and the signal word that appears on the original container.
_______ 4. I know that I must use accurate measuring devices when mixing pesticides, and never exceed the
INITIAL label rate for the commodity or site being treated.
_______ 5. Prior to applying a pesticide, I know I must evaluate my application equipment, weather conditions,
INITIAL the property to be treated, and surrounding properties in order to prevent damage, drift or

contamination to non-target crops, animals, people or other property.
_______ 6. I understand that pesticides must at all times be attended or kept in a locked storage.
INITIAL
_______ 7. I understand that I must never transport pesticides in the passenger compartment of any vehicle.
INITIAL
_______ 8. I understand that pesticides must be secured during transportation to prevent spillage and
INITIAL breakage.
_______ 9. I understand pesticides must never be stored or transported with people, food, or feed.
INITIAL
_______ 10. I understand that in no case shall a pesticides be placed or kept in any container of a type
INITIAL commonly used for food, drink, or household products.
_______ 11. I understand that I must mix pesticides in a well-ventilated and well-lit area.
INITIAL
_______ 12. I understand that when mixing pesticides I must pour the concentrate from below eye level to
INITIAL reduce the hazard of a splash.
_______ 13. I understand that I must handle all pesticide containers carefully. I must report all leaking
INITIAL containers and spills to my supervisor as soon as possible.
_______ 14. I understand that all empty pesticide containers are to be triple rinsed and rendered unusable
INITIAL before disposal.

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