Wisconsin Pesticide Application Recordkeeping Form for Private Applicators This form combines recordkeeping information required for Restricted Use Pesticides (RUP) and the Worker Protection Standard (WPS). Farm Name: _________________________________________________________________________________________________________ Restricted Interval (REI) Date: * # Total Active MM/DD/YR Crop or Mixing Location and Wind # of Amount of Applicator Ingredient # EPA Reg # Site & Description Speed/ Units Product (oz, Name and # Brand or Number * Time: * # Treated Loading of Treated Direction/ or pound, pint, Certification Time Product # Start/Stop * # Site * Area * # Temp Acres * quart, Number * Name * # (AM/PM) gallon) * Expiration: MO/DA (AM/PM) Duration *Required for RUP recordkeeping #Required for WPS recordkeeping In Wisconsin, private applicators must keep records of applications of restricted use pesticides for at least 2 years, 3 years for atrazine-containing pesticides. Worker Protection requires that pesticide application information be posted for 30 days then retained for 2 years. Safety Data Sheets (SDS) must also be posted for 30 days and retained for 2 years. [40 CFR Part 170.311(b)(1-7)
Wisconsin Pesticide Application Recordkeeping Form for Private Applicators This form combines recordkeeping information required for Restricted Use Pesticides (RUP) and the Worker Protection Standard (WPS). Farm Name: _________________________________________________________________________________________________________ Date: * # MM/DD/YR Time: * # Start/Stop (AM/PM) Crop or Site Treated * # Mixing & Loading Site * Location and Description of Treated Area * # Wind Speed/ Direction/ Temp Active Ingredient # Brand or Product Name * # EPA Reg Number * # # of Units or Acres * Total Amount of Product (oz, pound, pint, quart, gallon) * Applicator Name and Certification Number * Restricted Interval (REI) Duration # Expiration: MO/DA Time (AM/PM) # *Required for RUP recordkeeping #Required for WPS recordkeeping In Wisconsin, private applicators must keep records of applications of restricted use pesticides for at least 2 years, 3 years for atrazine-containing pesticides. Worker Protection requires that pesticide application information be posted for 30 days then retained for 2 years. Safety Data Sheets (SDS) must also be posted for 30 days and retained for 2 years. [40 CFR Part 170.311(b)(1-7)
WPSPestAppRecordWI.docx