RECORD KEEPING FORM – CHEMICAL USE
S = Start
F = Finish
Temp = Temperature
RH = Relative humidity
 = Not Mandatory
Records Group I Herbicides (2,4-D, 2,4-DB, MCPA, dicamba, triclopyr, picloram, clopyralid,
fluroxypyr)
Start a new form if the owner, user or equipment changes.
User Name:
User Address:
Contact Number:
Applicator has prescribed qualifications to apply Group I herbicides in SA
Property Owner:
Address:
As above you are user
Property address
Equipment
type
Nozzle type &
Flow rate
Date
Records held for 2
yrs from this date.
Record details within 24 hours of use
Paddock
Product name
Product
(including adjuvants) rate/ha
location or
Identification
NO
YES
You cannot apply this chemical
Contact Number:
Spray
pressure
Crop or
situation
Area treated
(ha)
Spray volume
(L/ha)
Spray times
A or P M
Wind
speed
Wind
Direction
Travel
Speed km
Temp
( C)
RH
%
Delta T
km/hr
S:
M
F:
M
S:
M
F:
M
S:
M
F:
M
S:
M
F:
M
S:
M
F:
M
This is an accurate record of chemical use. User signature:
Date:
20
Provide a copy of this form to the property manager/owner/business if different to user.
For additional copies of this form
Phone: (08) 8226 0549
Visit: www.pir.sa.gov.au/biosecuritysa/ruralchem Email: [email protected]