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HERBICIDE
APPL1CATION/
USAGE
REPORT
Agency:Please
Select-
Report
Data
Provided
By:
Report
Data
Entered
By:
Date:
1
HERBICIDE TRACKING REPORT
Agency: DPW Highways
Report Data Provided By:
Report Data Entered By:
Date:
Start Time: End Time:
CREW
Equipment Number(Truck#):
Supervisor Name:
Driver Name:
Sprayer Name:
PPE Used:
Boots/Shoes n Respirator(Full-Face)
Long Pants Respirator(Half-Face)
Long Sleeve Shirt Safety Glasses
Gloves Face Shield
Coveralls Other- Please Specify
LOCATION INFORMATION
Map Location:
Describe the location ofspraying)
Location Name/Street Name:
Location Type:
Drainageway Road Median
Roadside Shoulder Other- Provide Description
Roadside Sidewalk
Expected Public Exposure:
What is the expected public exposure at this location)
Low (Fence, Perimeter, Roadside)
Moderate (Sidewalk, Non-Recreational Grounds)
High (Playfield)
Length Completed (ft):
PRECAUTIONS
Weather Conditions:
Sunny/Clear Light Rain/Drizzle
n Partly Cloudy n Rain
Overcast Other- Provide Description
Anemometer(Model or COH Inventory#):
Wind Speed (MPH):
Wind Conditions:
Consistent Speed + Consistent Direction
Variable Speed + Consistent Direction
Variable Speed +Variable Direction
Temperature (F):
Relative Humidity(%):
Ground Surface Conditions:
Dry Wet
Damp Dewy
Notice Posted:
Yes No
Date:
Restricted Access:
No Other- Provide Description
Until Dry
How long was the herbicide-treated area secured from access after completion of
application (Hours):
Did anyone enter the restricted area:
Yes No
Did it rain before herbicide completely dried:
Yes No
HERBICIDE
Herbicide Purpose:
General Weed Control Selective Treatment
n Invasive Species Eradication n O• ther- Provide Description
HERBICIDE APPLICATION
Herbicide Name:
Round Up Pro Concentrate Finale
Aquamaster Diuron 4L
Milestone Garlon 4
Confront Clean Amine
Celsius WG Other- Provide Description
Gallons of water used:
Concentration (%) of prepared solution:
Additive/Adjutants Added:
Yes n N• o
Product Name:
Concentration (%):
Dye/Marker Used:
Yes No
Product Name:
Concentration (%):
Was entirety of prepared solution applied:
Yes No- Complete next two questions
Explain why the prepared solution was not all applied:
Describe what was done with the remaining solution:
If more than one herbicide was applied to the area please fill out another
form - HERBICIDE APPLICTION section only
ADDITIONAL INFORMATION
Task Completed:
Yes N• o
Issues Encountered:
Notes:
HERBICIDE TRACKING REPORT
Agency:
Division/Section:
Report Data Provided By:
Report Data Entered By:
Date:
Start Time: End Time:
CREW
Applicator:
PPE Used:
Boots/Shoes Respirator(Full-Face)
Long Pants Respirator(Half-Face)
Long Sleeve Shirt Safety Glasses
Gloves Face Shield
Coveralls Other- Please Specify
Application Equipment Used:
Type,Model, Capacity,etc)
Direct Supervisor (On day of application):
Supervisor:
LOCATION INFORMATION
Map Location:
Describe the location ofspraying)
Park/Facility/Site Name:
Expected Public Exposure:
What is the expected public exposure at this location)
Low (Fence, Perimeter, Roadside)
Moderate (Sidewalk, Non-Recreational Grounds)
High (Playfield)
PRECAUTIONS
Weather Conditions:
Sunny/Clear Light Rain/Drizzle
Partly Cloudy Rain
Overcast Other- Provide Description
Anemometer(Model or COH Inventory#):
Wind Speed (MPH):
Wind Conditions:
Consistent Speed + Consistent Direction
V• ariable Speed + Consistent Direction
Variable Speed +Variable Direction
Temperature (F):
Relative Humidity(%):
Ground Surface Conditions:
n D• ry Wet
D• amp Dewy
Notice Posted:
Yes No
Date:
Restricted Access:
Describe how access by the public was restricted)
Entire Park Closed Off Applicator Remained in Area for Duration
Area Fenced Off Other- Provide Description
S• ecurity Personnel Posted
How long was the herbicide-treated area secured from access after completion of
application (Hours):
Did anyone enter the restricted area:
Yes No
Did it rain before herbicide completely dried:
Yes No
HERBICIDE
Herbicide Purpose:
General Weed Control Selective Treatment
Invasive Species Eradication Other- Provide Description
HERBICIDE APPLICATION
Herbicide Name:
Round Up Pro Concentrate Finale
Aquamaster Diuron 4L
Milestone G• arlon 4
Confront C• lean Amine
Celsius WG n O• ther- Provide Description
Gallons of water used:
Concentration (%) of prepared solution:
Additive/Adjutants Added:
Yes No
Product Name:
Concentration (%):
Dye/Marker Used:
Yes No
Product Name:
Concentration (%):
Was entirety of prepared solution applied:
Yes No - Complete next two questions
Explain why the prepared solution was not all applied:
Describe what was done with the remaining solution:
If more than one herbicide was applied to the area please fill out another
form - HERBICIDE APPLICTION section only
ADDITIONAL INFORMATION
Task Completed:
Yes No
Issues Encountered:
Notes:
HERBICIDE TRACKING REPORT
Agency: Parks and Recreation
Division/Section:
Parks Maintenance Pana'ewa Zoo and Equestrian
Municiple Golf Course Elderly Activities
Recreation/Ho'olulu Administration/Other
Report Data Provided By:
Report Data Entered By:
Date:
Start Time: End Time:
CREW
Applicator:
PPE Used:
Boots/Shoes Respirator (Full-Face)
Long Pants Respirator(Half-Face)
Long Sleeve Shirt Safety Glasses
Gloves Face Shield
Coveralls Other- Please Specify
Application Equipment Used:
Type, Model, Capacity,etc)
Direct Supervisor(On day of application):
Supervisor:
LOCATION INFORMATION
Map Location:
Describe the location of spraying)
Park/Facility/Site Name:
Expected Public Exposure:
What is the expected public exposure at this location)
Low(Fence, Perimeter, Roadside)
Moderate (Sidewalk, Non-Recreational Grounds)
High (Playfield)
PRECAUTIONS
Weather Conditions:
Sunny/Clear Light Rain/Drizzle
Partly Cloudy n Rain
Overcast Other- Provide Description
Anemometer (Model or COH Inventory It):
Wind Speed (MPH):
Wind Conditions:
Consistent Speed + Consistent Direction
Variable Speed + Consistent Direction
Variable Speed +Variable Direction
Temperature (F):
Relative Humidity(%):
Ground Surface Conditions:
Dry Wet
Damp Dewy
Notice Posted:
Yes No
Date:
Restricted Access:
Describe how access by the public was restricted)
Entire Park Closed Off A• pplicator Remained in Area for Duration
Area Fenced Off O• ther- Provide Description
Security Personnel Posted
How long was the herbicide-treated area secured from access after completion of
application (Hours):
Did anyone enter the restricted area:
Yes n No
Did it rain before herbicide completely dried:
Yes No
HERBICIDE
Herbicide Purpose:
General Weed Control n Selective Treatment
Invasive Species Eradication l Other- Provide Description
HERBICIDE APPLICATION
Herbicide Name:
Round Up Pro Concentrate Finale
Aquamaster Diuron 4L
Milestone Garlon 4
Confront Clean Amine
Celsius WG Other- Provide Description
Gallons of water used:
Concentration (%) of prepared solution:
Additive/Adjutants Added:
Yes No
Product Name:
Concentration (%):
Dye/Marker Used:
Yes No
Product Name:
Concentration (%):
Was entirety of prepared solution applied:
Yes No - Complete next two questions
Explain why the prepared solution was not all applied:
Describe what was done with the remaining solution:
If more than one herbicide was applied to the area please fill out another
form - HERBICIDE APPLICTION section only
ADDITIONAL INFORMATION
Task Completed:
Yes No
Issues Encountered:
Notes: