"Pesticide Applicator Recertification Program Request for Credit Application Form" - Saskatchewan, Canada

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Pesticide Applicator Recertification Program
Request for Credit Application Form
(Including Multiple Sessions at a Workshop/Conference)
Complete this form to request credit approval of a meeting, informational session, workshop, clinic and/or other training event (including those with
multiple sessions) that is intended to meet requirements for pesticide applicator recertification through a continuing education program (as specified by the
Standard for Pesticide Education, Training and Certification in Canada). If you have any questions, please contact Rich Wilkins (306) 787-5207.
Submit (mail or fax) the completed form to: Saskatchewan Ministry of Agriculture
Crops Branch
Room 125, 3085 Albert Street
Regina, Sask., S4S 0B1
Facsimile: (306) 787-0428
1. Identify the Coordinator of this Session Requesting Approval for credits:
a. Name:______________________________________Phone Number:____________________ Fax Number:______________________
b. E-mail address:_________________________________________ Internet Address of Conference:______________________________
c. Organization: __________________________________________Address:_________________________________________________
2. Conference/Workshop Name:____________________________________Conference/Workshop Date(s):_________________
3. Location:___________________________________________
4. ATTACH THE CONFERENCE/WORKSHOP AGENDA THAT PROVIDES DETAILS OF THE SESSION TOPICS.
5. ATTACH A BIOGRAPHY FOR EVERY PRESENTER.
6. Sessions approved for credit will be posted on the Saskatchewan Agriculture website (www.agriculture.gov.sk.ca) under Forms | Pesticide Forms.
Please indicate the Agency/Association name and phone number to call to register for the course (as you would like it to appear on our website).
Page 1 of 4
Pesticide Applicator Recertification Program
Request for Credit Application Form
(Including Multiple Sessions at a Workshop/Conference)
Complete this form to request credit approval of a meeting, informational session, workshop, clinic and/or other training event (including those with
multiple sessions) that is intended to meet requirements for pesticide applicator recertification through a continuing education program (as specified by the
Standard for Pesticide Education, Training and Certification in Canada). If you have any questions, please contact Rich Wilkins (306) 787-5207.
Submit (mail or fax) the completed form to: Saskatchewan Ministry of Agriculture
Crops Branch
Room 125, 3085 Albert Street
Regina, Sask., S4S 0B1
Facsimile: (306) 787-0428
1. Identify the Coordinator of this Session Requesting Approval for credits:
a. Name:______________________________________Phone Number:____________________ Fax Number:______________________
b. E-mail address:_________________________________________ Internet Address of Conference:______________________________
c. Organization: __________________________________________Address:_________________________________________________
2. Conference/Workshop Name:____________________________________Conference/Workshop Date(s):_________________
3. Location:___________________________________________
4. ATTACH THE CONFERENCE/WORKSHOP AGENDA THAT PROVIDES DETAILS OF THE SESSION TOPICS.
5. ATTACH A BIOGRAPHY FOR EVERY PRESENTER.
6. Sessions approved for credit will be posted on the Saskatchewan Agriculture website (www.agriculture.gov.sk.ca) under Forms | Pesticide Forms.
Please indicate the Agency/Association name and phone number to call to register for the course (as you would like it to appear on our website).
Page 1 of 4
7. Check the licence category of applicator for which this training would be applicable:
_____ Aerial
_____ Greenhouse
_____ Structural
_____ Dispenser Certification
_____ Agriculture
_____ Industrial Vegetation
_____ Seed Treatment
_____ Other (please describe):
_____ Aquatic Vegetation
_____ Landscape
_____Grain Fumigation
__________________________
_____ Fumigation
_____ Mosquito & Biting Fly
_____ Rat Control
8. Indicate the session names, type of activity, the concepts and subconcepts that will be discussed and the time allotment for the session.
NOTE:
- one credit is awarded for one hour of training
- no part credits will be awarded if a session lasts less than one hour (sessions may be combined to provide a full credit)
- a maximum of 10 credits will be approved for any session.
1
2
2
Session Name
Presenter
Type of Activity*
Concept to be covered*
Subconcepts to be covered*
Time
(see attached list)
(see attached list)
(see attached list)
allotment
(hours)
Page 2 of 4
1
2
2
Session Name
Presenter
Type of Activity*
Concept to be covered*
Subconcepts to be covered*
Time
(see attached list)
(see attached list)
(see attached list)
allotment
(hours)
1
*
Types of activities:
 lecture only
 video (part of a presentation or stand-alone video where the presenter verifies participant’s presence)
 quiz (questions all participants answer individually; quiz marked by instructor or answers discussed in session)
 slides/overheads, PowerPoint presentation (to illustrate concepts or examples)
 handouts (summary of presenter’s main points)
 discussion (small group discussions of information provided by presenter)
 demonstration (e.g. presenter shows how a piece of equipment works)
 self-guided study (course where hand-written study guides submitted upon completion)
 one-on-one interaction with instructor (e.g. instructor and participant calibrate equipment together)
 hands-on clinic (small groups where participants involved in activity, e.g. participants identify pests)
 interactive computer program (participant completes exercises or questions while in on-line program. Certificate of Completion generated by program manager)
 workshop (participants develop a unique item, e.g. each participant develops their own site-specific emergency response plan)
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2
2
2
2
*
Concept
Subconcept*
*
Concept
Subconcept*
Pesticide Terminology /How pesticides Work
Fate of pesticides
Environment
Grouping Pesticides (chemical families, Mode of
General Information
(minimum 1
Contamination Sources
Action, etc.)
3
credit*
in 5 years)
Formulations /Tank Mixes
Aquatic Impact
Pest Control Products Act (Canada & Sask)
Land Impact (soil, animals, beneficials, plants)
Environmental Management & Protection Act
Regulations
Air Impact
(Sask)
(minimum 2
3
credits*
in 5 years)
Occupational Health & Safety Act
Weed characteristics, management and IPM
Herbicide characteristics and factors affecting
Pest Management
Pest Control Act (Sask)
efficacy
(minimum of 2
3
Transportation of Dangerous Goods Act
credits*
in 5
Insect characteristics, management and IPM
years)
Other Act: (please
Insecticide characteristics and factors affecting
specify)_____________________________
efficacy
Components and Interpretation of labels
Disease characteristics, management and IPM
Labelling
Fungicide characteristics and factors affecting
Material Safety Data Sheets (MSDS)
efficacy
Toxicology
Vertebrate pest management and IPM
Human Health and
Vertebrate pesticide characteristics and factors
Acute/Chronic Toxicity
Pesticide Safety
affecting efficacy
(minimum 2
Exposure/Poisoning Symptoms
Selection and components of application equipment
3
credits*
in 5 years)
Application
Risk and Attitude
Operation and calibration of application equipment
Technology
Precautions and safe procedures for pesticide
(minimum 2
Maintenance and storage of application equipment
handling and use
3
credits*
in 5
years)
Protective clothing and equipment
Environmental conditions affecting application
Transportation of pesticides
Spills/spill response kits/spill response
Pesticide Storage
Fires
Emergency
Response
Mixing and loading and application of pesticides
First Aid
Cleanup and maintenance of equipment
Emergency Response Plan
Disposal
Knowledge/Attitude and Work Habits/Activities
Professionalism
Re-entry intervals
Communication
Application records
3
*
Minimum number of credits required/concept. A minimum of 15 credits is required over a five-year period.
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