Pesticide Risk Assessment Form
Evaluate pesticide use risks and operational context to ensure safety and compliance.
Pesticide Type
*
Please Select
Herbicide
Insecticide
Fungicide
Rodenticide
Other
Application Method
*
Ground spray
Aerial spray
Seed treatment
Soil incorporation
Other
Level of Operator Training
*
No formal training
Basic safety training
Certified pesticide applicator
Personal Protective Equipment (PPE) Used
*
Gloves
Protective clothing
Eye protection
Respirator
None
Proximity to Sensitive Areas
*
Near water bodies
Near residential areas
Near crops for human consumption
No sensitive areas nearby
Weather Conditions During Application
*
Calm, no wind
Light wind (<10 km/h)
Moderate wind (10-20 km/h)
Strong wind (>20 km/h)
Rain expected
Exposure Risk Assessment
*
Very Low
1
2
3
4
Very High
5
1 is Very Low, 5 is Very High
Environmental Risk Assessment
*
Negligible
1
2
3
4
Critical
5
1 is Negligible, 5 is Critical
Incident History (Past 12 Months)
*
Rows
Never
Once
More than once
Spills
1
2
3
Operator exposure
4
5
6
Non-target effects
7
8
9
Equipment malfunction
10
11
12
Submit Assessment
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