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Pest control service report
Business name
Phone, email, website
Business license no.
Report no.
Date of service
Time in / time out
Customer and technician
Customer name
Service address
Phone, email
Technician
Applicator license no.
Service type☐ Initial ☐ Recurring ☐ Callback ☐ Inspection
Findings
Pests targeted
Pests observed, where, activity level
Areas inspected
Areas treated
Products applied
| Product name | EPA Reg. No. | Active ingredient | Rate / dilution | Amount applied | Area or site | Target pest | Method |
|---|
| | | | | | | |
| | | | | | | |
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| | | | | | | |
Devices, conditions and recommendations
Devices installed or checked (bait stations, traps, monitors)
Conducive conditions found
Recommendations to the customer
Precautions given (as stated on the product label)
Weather (outdoor): temp., wind
Next scheduled service
Technician signature
Customer signature or "not present"
Product details copied from the product label. Keep a copy with your application records for the period your state requires.