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Pesticide Record Keeping Forms

These forms serve as examples of the minimum record-keeping requirements for given license types. You may use them, but they’re not required if you record the same information on your own invoices or documents.

Record-Keeping Forms for Commercial Applicators (4001)

For non-agricultural commercial applications. This information needs to be retained for two years.
For commercial applicators applying to agricultural establishments: This information needs to be retained by the applicating company. This information must be provided to your customer for them to display in their central posting area for 30 days after the REI.

Record-Keeping Form for Non-commercial Applicators (4002)

Non-commercial applicators only need to record their Restricted Use Pesticides (RUP) applications, but may also use it to record General Use Pesticides (GUP) applications. It is the applicator’s responsibility to maintain this information for two years.

Record-Keeping Forms for Private Applicators (4003)

If your agricultural establishment is subject to the Worker Protection Standard (WPS), record and display this information at your central posting area.
If your agricultural establishment is not subject to the Worker Protection Standard, and you are applying a Restricted Use Pesticide (RUP), you must record this information.