Appendix B also includes several fact sheets to help you
comply with sections of the WPS that require you to provide
information to others. Although the WPS does not
require you to provide this information in written form,
you may find that using photocopies of these fact
sheets is a convenient way to make sure you convey
all the necessary information.
Finally, Appendix B includes some checklists you can
use as reminders of your WPS duties.
Pesticide Application List
Fact Sheets:
_________________________________________________________________________
Application #1 Application #2
_________________________________________________________________________
Area Treated:
Location & Description
_________________________________________________________________________
Product Name
_________________________________________________________________________
EPA Registration
Number
_________________________________________________________________________
Active Ingredient:
Common or
Chemical Name
_________________________________________________________________________
Application:
Month/Day/Time
_________________________________________________________________________
Restricted Entry Interval
_________________________________________________________________________
Do Not Enter Until:
Month/Day/Time
_________________________________________________________________________
Similar data is required by the Federal Recordkeeping Requirements for Certified Applicators of Fedffally Restricted Use Pesticides (RUP). For more information on the RUP recordkeeping requirements, contact AgTicultural Marketing Service, USDA, 8 700 Centerville Rd, Manassas, VA 22110. (703) 330- 7826.
__________________________________________________________________________
Application #1 Application #2
__________________________________________________________________________
Areas to be Treated or
Under Restricted
Entry Intervals:
Location & Description
__________________________________________________________________________
Entry Restricted Until:
Month/Day/ Time
__________________________________________________________________________
PPE Required for Handlers*
__________________________________________________________________________
Early Entry PPE Required
for Workers*
__________________________________________________________________________
* The only early entry allowed is that which is permitted
by the 1992 Federal Worker Protection
Custom Applicators
Custom (for Hire) Applicators: The use of this form is optional,
but you must provide this
information to the agricultural owners and operators who hire you to apply
pesticides. This
information is necessary to assure that the grower's employees are
protected according to the 1992
Federal Worker Protection Standard.
See earlier section of the EPA manual
"The Worker Protection Standard for Agricultural Pesticides:
How To Comply."
_________________________________________________________________________
Application #1 Application #2
_________________________________________________________________________
Area to be Treated:
Location & Description
_________________________________________________________________________
Product Name
_________________________________________________________________________
EPA Registration Number
_________________________________________________________________________
Active Ingredient:
Common or Chemical Name
_________________________________________________________________________
Application:
Month/Day/Time*
_________________________________________________________________________
Entry Restricted Until:
Month/Day/Time
_________________________________________________________________________
Are Both Treated Area Posting
and Oral Notification Required?
_________________________________________________________________________
PPE Required for Handlers**
_________________________________________________________________________
Early Entry PPE Required for
Workers**
_________________________________________________________________________
Other Label Requirements to
Protect Workers & Others
_________________________________________________________________________
*If the pesticide is not applied as scheduled, the customer must be
notified of the corrected time and date before the application, or as
soon as possible after the application.
Have you given your agricultural workers all the
protections required by the EPA Worker Protection
Standard? Use this list as a reminder. Remember that
you have duties to persons other than your worker
employees. For complete explanations, refer to
"The
Worker Protection Standard for Agricultural Pesticides-How To Comply."
Information at a central location (WPS safety poster,
application list,
location of emergency medical facility)
Pesticide safety training for workers
Decontamination sites (water, soap, towels, etc.)
Emergency assistance (transportation and information)
Restrictions during applications (do not allow workers in area)
Special application restrictions in nurseries
Special application restrictions in greenhouses
Restrictions during restricted-entry intervals
(and limitations on early
entry)
Notice about applications (oral warnings and treated area posting)
Checklist: WPS Requirements for Pesticide Handlers
Have you given your pesticide handlers all the
protections required by the EPA Worker Protection
Standard? Use this list as a reminder. Remember that
you have duties to persons other than your handler
employees. For complete explanations, refer to
"The
Worker Protection Standard for Agricultural Pesticides-How To Comply."
Information at a central location (WPS safety poster, application list,
location of emergency medical facility)
Pesticide safety training for handlers
Decontamination site (water, soap, towels, change of clothing, etc.)
Emergency assistance (transportation and information)
Equipment safety (inspection and maintenance of application equipment)
Personal protective equipment (provide, clean, maintain PPE, and prevent
heat illness)
Checklist: WPS Requirements for Commercial Handlers
Have you given the handler employees of your
commercial pesticide handling establishment all the
protections required by the EPA Worker Protection
Standard? Use this list as a reminder. Remember that
you have duties to persons other than your handler
employees. For complete explanations, refer to
"The Worker Protection Standard for
Agricultural Pesticides-How To Comply."
Pesticide safety training for handlers
Decontamination site (water, soap, towels, change of clothing, etc.)
Emergency assistance (transportation and information)
Equipment safety (inspection and maintenance of application equipment)
Personal protective equipment (provide, clean, maintain PPE, and prevent
heat illness)
Checklist: WPS Exemptions
for Agricultural Owners
Although agricultural owners are encouraged to give all 'I
WPS protections to themselves and their families*, the
WPS does not REQUIRE them to provide themselves or
members of their immediate family with the following:
Information at a central location (WP sa@ety poster,
application list, and location of emergency medical facility)
Pesticide safety training for workers or handlers
Decontamination sites (water, soap, towels, change of clothing, etc.)
Emergency assistance (transportation andinformation)
Notice about applications (oral warnings and treated area posting)
Specific handling instructions (pesticide label information and how to use
application equipment)
Equipment safety (inspection and maintenance of application equipment)
The following duties related to early entry: