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Use a pest management plan example template for health and safety

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Audit
Site Details
Building/Area Description
Construction Type
Wind 0-10
Pests Treated
Cockroaches
Rodents
Birds
Bird Lice
Ants
Spiders
Borers
Termites
Fleas
Silverfish
Mosquitoes
Bees
Wasps
Ticks
Other- Type In
Treatment Area(s)
Internal
External
Chemical Used & Quantity
Termidor (Fipronil 100gms/Ltr)
Biflex Ultra Low Odour (Bifenthrin 100gms/Ltr)
Biflex Aquamax (Bifenthrin 100gms/Ltr)
Cislin (Deltamethrin 25gms/Ltr)
Ditrac Blocks (Brodifacoum 0.005%)
Dragnet Dust (Permethrin 20gms/Kg)
Maxforce Gold Cockroach Gel (Fipronil 0.3gms/Kg)
Optiguard Ant Gel (Thismethoxam 0.1gms/Kg)
Battle Axe Areosol (Propoxur 20gms/Kg, Tetramethrin 2gms/Kg)
Maxforce Granular (Hydramethylnon 10gms/Kg)
Cislin Ultra Aerosol (Bioallethrin 1.5gms/Ltr, Deltamethrin 0.2gms/Ltr)
Amdro Ant Granular (Hydramethylnon 7.3gms/Kg)
Advion Ant Gel (Indoxacarb 6gms/Kg)
Advion Cockroach Gel (Indoxacarb 6gms/Kg)
Stratagem Blocks (Flocoumafen 0.05gms/Kg)
Antmaster (Imidacloprid 0.05gms/Ltr)
Chill (D-allethrin 1.3gms/Kg)
Aquatain AMF (Polydimethylsiloxane 754gms/Ltr)
Amdro Cockroach Gel (Hydramethylnon 20gms/Kg)
Other- Type In
Service Type
Regular
Warranty
Scheduled
Warranty Provided
Warranty Period
Additional Information
Comment/Recommendations
Add media
Technician
Add signature
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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.