"Pesticide Safety Training Record Chart Template"

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PESTICIDE SAFETY TRAINING RECORD
LIST OF NAMES OF PESTICIDES COVERED IN TRAINING
1.
9.
2.
10.
3.
11.
4.
12.
5.
13.
6.
14.
7.
15.
8.
16.
TRAINER QUALIFICATIONS
Trainer Name:
Trainer Qualifications: (Please check)
[ ] Private Applicator Certificate
[ ] Qualified Applicator License
[ ] Qualified Applicator Certificate
[ ] Pest Control Advisor
[ ] Pest Control Operator
[ ] Train the Trainer Certificate; UC Extension IPM
[ ] Other:
PESTICIDE SAFETY TRAINING RECORD
LIST OF NAMES OF PESTICIDES COVERED IN TRAINING
1.
9.
2.
10.
3.
11.
4.
12.
5.
13.
6.
14.
7.
15.
8.
16.
TRAINER QUALIFICATIONS
Trainer Name:
Trainer Qualifications: (Please check)
[ ] Private Applicator Certificate
[ ] Qualified Applicator License
[ ] Qualified Applicator Certificate
[ ] Pest Control Advisor
[ ] Pest Control Operator
[ ] Train the Trainer Certificate; UC Extension IPM
[ ] Other:
The following employee(s) have received pesticide training.
EMPLOYEE NAME
EMPLOYEE SIGNATURE
JOB ASSIGNMENT
DATE OF
TRAINING
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
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