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Pesticide Application Record

One row per application. Federal RUP fields (7 CFR 110.3) plus common state fields.

Company / business license no.
Applicator name
Applicator license / certification no.
Supervising certified applicator (if applicator is uncertified)
Record period

Application log

DateStart-end timeCustomer + service address (ZIP)Area treated + sizeTarget pestProduct (brand)EPA reg. no.Conc. / total amountMethod
         
         
         
         
         
         
         
         
         
         
         
         

Outdoor applications: weather (required in some states, e.g. IA, WA)

DateAddressTempWind directionWind speedNotes
      
      
      
      
      

Termite jobs: measurements and diagram (required in some states, e.g. TX, OH, IL)

Address / date
Linear feet treated / units
Barrier measurements
Diagram attached (Y/N)

Retention and delivery

General information, not legal advice. State recordkeeping rules change; check your state agency.

Free template from PestRouteDesk. Edit freely for your business.