WRITTEN PESTICIDE SAFETY TRAINING PROGRAM

Grower/Company Name _____________________________________________________________________________



Address _________________________________________________ Phone___________________________________



Trainer/Person responsible for program _________________________________________________________________



The following materials and information have been provided and used to train employees in Pesticide Safety

(e.g., study guides, pamphlets, pesticide labels, P.S.I.S., M.S.D.S., slides, videos):



1. ______________________________________________ 4. ____________________________________________



2. ______________________________________________ 5. ____________________________________________



3. ______________________________________________ 6. ____________________________________________



THE PESTICIDE TRAINING PROGRAM COVERS THE FOLLOWING SUBJECTS FOR EACH PESTICIDE, OR

CHEMICALLY SIMILAR GROUP OF PESTICIDES TO BE USED:



1.     The format and meaning of information contained in pesticide product labeling:

       a.     Precautionary statements about human health hazards

       b.     Signal words and their meaning



2.     The hazards of pesticides:

       a.     Acute and chronic effects

       b.     Delayed effects and sensitization

       c.     Information can be found in pesticide labeling, Material Safety Data Sheets (MSDS) and Pesticide Safety

              Information Series (PSIS)



3.     The routes by which pesticides can enter the body:

       a.      Ingestion

       b.      Inhalation

       c.      Dermal contact and absorption

       d.      Information found in labeling, MSDS and PSIS



4.     The signs and symptoms of overexposure:

       a.      Information found in labeling, MSDS and PSIS



5.     Emergency first aid for pesticide overexposure:

       a.    Location of decontamination facilities

       b.    Location of first aid kits

       c.    Information found in labeling, MSDS and PSIS



6.     How to obtain emergency medical care:

       a.     Posting of name, address and phone number of medical facility at each work site

       b.     Plan for emergency procedures in advance

       c.     Company policy for notification



7.     Routine and emergency decontamination procedures:

       a.      Spill or leak clean up

       b.      Need to thoroughly shower after exposure period

       c.      Whom to notify in case of an emergency



8.     Need for, limitations, appropriate use, and sanitation of personal protective equipment:

       a.     Coveralls (laws & regs./labeling/MSDS/PSIS)

       b.     Gloves (laws & regs./labeling/MSDS/PSIS)

       c.     Eye Protection: goggles, safety glasses, faceshield (laws & regs./labeling/MSDS/PSIS)

       d.     Chemical Resistant Footwear (laws & regs./labeling/MSDS/PSIS)

       e.     Chemical Resistant Headgear (laws & regs./labeling/MSDS/PSIS)

       f.     Chemical Resistant Apron (laws & regs./labeling/MSDS/PSIS)

       g.     Chemical Resistant Suit (laws & regs./labeling/MSDS/PSIS)

         h.       Respiratory Protection (air-purifying & air-supplying)

                  �? Laws & regs./labeling/MSDS/PSIS

                  �? NIOSH/MSHA approved

                  �? Initial and annual training

                  �? Adoption of written operating procedures/training program (PSIS A-5)

                  �? No facial hair

                  �? Monthly inspection for standby or emergency respirators

                  �? Medical Condition Statement

         i.       Exceptions and substitutions to personal protective equipment required by labeling or regulations



9.       Prevention, recognition and first aid for heat related illness:

         a.      Heat factors

         b.      Workload

         c.      Personal protective equipment

         d.      Drinking water intake

         e.      Scheduling



10.      Safety requirements and procedures for handling, transporting, storing and disposing of pesticides:

         a.      Engineering controls

                 �? Closed systems

                 �? Enclosed cabs (type I vs. type II)

         b.      Procedures for opening, lifting, pouring and operating mixing and application equipment

         c.      Proper storage facilities: locked and posted

         d.      Procedures for triple rinsing and disposal of containers

         e.      Transporting pesticide containers: secured to prevent spillage

         f.      Container requirements: no household containers (food/drink)

         g.      Service container labeling



11.      Environmental concerns:

         a.     Drift

         b.     Runoff

         c.     Wildlife hazards



12.      Warnings about taking pesticide containers home



13.      Applicable laws and regulations:

         a.      Worker safety requirements/worker protection standards

         b.      Labeling requirements

         c.      Material Safety Data Sheets

         d.      Pesticide Safety Information Series leaflets



14.      The purposes and requirements of medical supervision (ag production):

         a.     Organophosphates or carbamates (�?  DANGER”or �?   WARNING�?    )

         b.     Maintenance of use records by employee



15.      The location of required documents:

         a.      Hazard communication information for employees handling pesticides (PSIS A-8)

         b.      Application specific information/Application completion notices

         c.      Material Safety Data Sheets

         d.      Employee exposure and monitoring data

         e.      Pesticide Safety Information Series leaflets



16.      The employee�? rights:

                      s

         a.    Right to receive exposure information

         b.    Protection against retaliatory action



___________________ (Company) trains every employee who is expected to handle pesticides before the employee is allowed to

handle these materials. Training is continually updated to cover any new pesticides that will be handled and repeated at least annually.

The date and extent of initial and annually required training and the assigned job will be recorded and verified by the employee�?

                                                                                                                                s

signature. The records will be retained for at least two years at a central location at the workplace.



The required documents and records are located at __________________________ and are accessible for review.