PUT SAFETY INTO PRACTICE !
PESTICIDE SAFETY EVALUATION

Improper pesticide application may contaminate the environment, the public, and the applicator. This session on the pesticide label was designed to give you information on pesticide safety. We hope you have learned new skills that you will use while applying pesticides in your home and garden. We want to know if this session met your needs. Your response on this form will help us design better educational programs. Thanks for your help.

List 3 new safety practices that you can use in your home or garden that will reduce pesticide exposure:

 
 

a.  ______________________________________
 
 

b.  ______________________________________
 
 

c.  ______________________________________
 
 
 
 

(Do not mark in this space)

[ ] Used at least once

[ ] Adopted routinely

[ ] Used at least once

[ ] Adopted routinely

[ ] Used at least once

[ ] Adopted routinely

[ ] Have not applied pesticides
since training. Name 



Address 

City/State


Zip code __________________                        Phone   ______________________

CONFIDENTIAL INFORMATION
Keep the pink copy for your files. Give the yellow and white copies to the trainer.