Pesticide Application Record Form
A one-visit record of a pesticide application for pest control and lawn care technicians. Records each product with its EPA registration number, the rate and amount applied, the target pest, the sites treated, and the applicator's license, with a copy for the customer.
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Generate PDF →Template only, not legal advice. Have an attorney licensed in your state review this template before using it with clients.
What’s in this template
Pesticide Application Record
Recordkeeping notice. Pesticide recordkeeping rules are set by your state's pesticide regulatory agency, usually the department of agriculture. Check its current list of required fields, the customer copy rule and the retention period, and add anything it requires that this form does not cover. This form is not legal advice.
1. Company and Applicator
- Company: Company Name
- Company address: Company Address
- Company phone: Company Phone
- Applicator: Applicator Name
- Applicator license or certification no.: Applicator License or Certification No.
- Supervising certified applicator and no., if any: Supervising Certified Applicator and No.
2. Customer, Date and Time
- Customer: Customer Name
- Application address: Application Address
- Date of application: Date of Application
- Time of application: Time of Application
3. Products Applied
Copy the brand name and EPA registration number from the product label in hand. Record the dilution or rate and the total amount applied for each product.
| Brand name (from label) | EPA Reg. No. | Dilution or rate | Total amount applied |
|---|---|---|---|
| Product 1: Brand Name | Product 1: EPA Reg. No. | Product 1: Dilution or Rate | Product 1: Total Amount Applied |
| Product 2: Brand Name | Product 2: EPA Reg. No. | Product 2: Dilution or Rate | Product 2: Total Amount Applied |
| Product 3: Brand Name | Product 3: EPA Reg. No. | Product 3: Dilution or Rate | Product 3: Total Amount Applied |
- Restricted use pesticide applied (yes or no): Restricted Use Pesticide Applied?
4. Target Pests and Sites Treated
- Target pest(s): Target Pest(s)
- Size of area treated: Size of Area Treated
- Application method and equipment: Application Method and Equipment
Specific sites treated
Specific Sites Treated
5. Conditions and Instructions
- Weather at application (outdoor work): Weather at Application (outdoor work)
Re-entry and precaution instructions given to the customer
Re-entry and Precaution Instructions Given
Notes
Notes
6. Signatures
The applicator confirms that the products above were applied as recorded and according to their labels. The customer acknowledges receiving a copy of this record.
Applicator signature line
Customer (copy received) signature line
Pesticide application record questions, answered
What goes on a pesticide application record?
The fields most state rules ask for: the product brand name and EPA registration number, the dilution or rate and the total amount applied, the target pest, the date, the address and the specific sites treated, and the applicator's name and license number. Many states also ask for the time of application or the weather for outdoor work, so the form has room for both.
How long do I have to keep pesticide application records?
Your state sets the period and it varies, so check the rule with your state pesticide regulatory agency, usually the department of agriculture. If you work in more than one state, keep every record for the longest period any of them requires.
Does the customer get a copy?
Many states require it, and the rules differ on timing. Some want the record left at the property when the work is done, others allow delivery within a set number of days. Leaving the customer copy before you drive away covers you either way.
Do I need a record for every application, or only for restricted use pesticides?
Plan on every application. State rules for pest control and lawn care businesses usually cover all commercial applications, not only restricted use products. USDA withdrew the federal restricted use recordkeeping rule in 2025, which leaves your state's rule as the one you are inspected against.
Do I need an account to use this form?
No. Download the blank form and print it, or fill it in online and download a PDF. Neither needs an account.
Fill in the record before you leave the property
Copy this record into EosLog Field Forms and your technician fills it in on the job from the mobile app. The customer signs on the phone and a PDF copy is saved to the job.