Agricultural Chemical Inputs

Agricultural Chemical Inputs0

Instructions: Includes all applications from pre-planting through to, and including, harvest. One Form must be completed for EACH PRODUCTION SITE.

Producer Name: / Previous Year Crop(s): / Current Crop:
Production Site Information (e.g., Field # or Name/ID): / Production Site Area
(e.g., # of acres/hectares): / Date Planted: / Variety:
Application
Date / Product/Trade Name and PCP # and Lot # / Actual Quantity Used (e.g., 22.28 kg) / Rate Applied
Per Unit (e.g., hectare, acre, cwt, tonne) / Label Instructions Followed (ü) / Area Treated / Method of Application
(e.g., air, ground, furrow, seed, foliar) / Earliest Allowable Harvest Date and PHI / Weather Conditions / Signature of
Applicator or if Custom Application Invoice is Attached

0 Canadian Horticultural Council, Combined Vegetable Producer, Storage Intermediary and Packer On-Farm Food Safety Manual, Version 4.0, 2010, Canadian Horticultural Council.