Form library · Facilities and maintenance
Pesticide application record template
For authorised people recording a grounds pesticide application. Record treatment authority, product and application and conditions and controls. Try the form below, see every question or download a blank PDF or Word copy.
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What determines permitted pesticide use?
HSE guidance explains that pesticide use must follow the product authorisation and label and that professional users must keep application records. Check the current requirements for the nation, product and use; registration duties may also apply.
Last updated . Facts checked by the SiteSurvey team on 6 October 2026 against HSE pesticide use questions and records and HSE registering work involving pesticides.
Try the grounds pesticide application record form live
Answer a few questions and watch it adapt. Your answers are not saved, and any photos you add are deleted within the hour.
This is the real form as your team would use it: questions appear as you answer, scores work themselves out and you can add photos and signatures. No sign-up needed.
Want to see one filled in? See a completed grounds pesticide application record report (PDF), made by SiteSurvey from a fictional site visit.
Fill it in on a phone or tablet
Your team completes the grounds pesticide application record on site in the SiteSurvey app on iPhone, iPad and Android phones and tablets. The project name and address fill in for them, it works without signal, and it syncs when the device is back online with photos kept against the question they answer.
Customers and subcontractors do not need the app: send them a link and they can fill it in from any browser.
Every question in the grounds pesticide application record template
A professional grounds pesticide record covering the treatment area, authorised product, application details, weather, exposure controls and follow-up. 6 sections and 33 questions. Follow-up questions and guidance appear only when an answer calls for them, so the person on site never sees the ones that do not apply.
Make it your own: every question is editable
This is a starting point, not a fixed form. Once it is in your SiteSurvey account you can reword any question, add or remove questions, sections and answer options, and add your own logo, so it fits the way your team works and the jobs you do.
Details you only enter once
Add this form to a project in SiteSurvey and it fills in what the project already knows, so nobody on site retypes it and every form on the job uses the same names. Anything filled in can still be changed.
- Project: the project name
- Site or premises address: the site address, from the space or the project
- Client or organisation: the project's customer
- Product name and authorisation number: the product it is opened for
Record details and scope
- ProjectShort answer
Filled in from the project in SiteSurvey.
Fills in from the project name - Site or premises addressShort answerFills in from the site address, from the space or the project
- Client or organisationShort answerFills in from the project's customer
- Record date*Date
- Person completing the record*Short answer
- CheckFor competent professional grounds users recording authorised plant protection product use. This is not a product recommendation, rate calculator, application permission or proof that every legal record requirement is met.
- CheckHSE guidance explains that pesticide use must follow the product authorisation and label and that professional users must keep application records. Check the current requirements for the nation, product and use; registration duties may also apply.
Treatment authority
- Site and treated area reference*Short answer
- Target weed, pest or disease and need for treatment*Short answer
- Operator and competence reference*Short answer
- Risk assessment and alternative-control decision*Short answer
Product and application
- Product name and authorisation number*Short answerFills in from the product it is opened for
- Current label/use authorisation reference*Short answer
- Application date and start/finish times*Short answer
- Actual dose/rate and units from approved use*Short answer
Record the actual rate and units with the current product label reference. Do not use a generic example as an application instruction.
- Area treated, product quantity and water volume with units*Short answer
- Application equipment and calibration reference*Short answer
Conditions and controls
- Wind, temperature and other relevant conditions*Short answer
- Public exclusion, drift, water and habitat controls*Notes
- Exposure controls and label PPE referenceShort answer
- Surplus, washings and container handling referenceShort answer
Completion
- Departures, incidents and escalationNotes
- Re-entry restriction and signage/notificationShort answer
- Effectiveness and follow-up reviewShort answer
Actions and review
- Are further actions required?*Choose one
- Yes
- No
- Further actionRepeat for each further action. Each one asks:Shown when “Are further actions required?” is “Yes”
- Action and evidence reference*Notes
- Person responsible*Short answer
- Target dateDate
- Action status*Choose one
- Open
- In progress
- Completed
- Completion evidence*NotesShown when “Action status” is “Completed”
- Outstanding limitations and information to pass onNotes
- Record status*Choose one
- Ready for review
- Further work needed
- Work or use stopped
- Reviewed byShort answer
- Review dateDate
- Author signature*Signature
- CheckSigning records the information entered. It does not itself certify legal compliance, remove a limitation or authorise unsafe work.
Scope and responsibility
For competent professional grounds users recording authorised plant protection product use. This is not a product recommendation, rate calculator, application permission or proof that every legal record requirement is met.
What a useful entry looks like
Actual dose/rate and units from approved use
Record the actual rate and units with the current product label reference. Do not use a generic example as an application instruction.
Actual application rate entered from the job record and linked to the authorised product label. Treated area and total amount are recorded separately.
Fictional example of record wording. Use the actual evidence and approved arrangements for your job; this is not a completed report or an instruction to carry out the work.
See it filled in
A completed grounds pesticide application record report, made by SiteSurvey from a fictional site visit: every answer, the photos, the guidance that applied and the sign-off, ready to send as a PDF.
Grounds Pesticide Application Record FAQs
How should I record “Actual dose/rate and units from approved use”?
Record the actual rate and units with the current product label reference. Do not use a generic example as an application instruction.
Does it choose a product or dose?
No. Record authorised use and actual application under the current label and competent procedure.
Can the same rules be assumed throughout the UK?
No. Check nation-specific requirements and current product authorisation.
Does saving the record notify anyone?
No. Record any required notification performed through the appropriate separate process.
What are the limits of this template?
For competent professional grounds users recording authorised plant protection product use. This is not a product recommendation, rate calculator, application permission or proof that every legal record requirement is met.
Can I complete this form on site and share the record?
In the SiteSurvey app the form works offline, with signatures recorded against the questions. Share the completed record as a PDF or a link. Dates and action owners are recorded fields; this form does not send reminders or update other systems.
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