Report Pesticide Drift or Exposure
If you experience pesticide drift or exposure, be sure to record the following information as soon as possible! Don’t worry if you don’t know all the answers — just record as much as you can.
Date of pesticide exposure
MM
/
DD
/
YYYY
Time of pesticide exposure
Time
:
Location of exposure: (Be specific! Address, intersection, part of highway, school name, field block, residence, name of farm labor contractor or grower if known, etc.)
Your answer
The exposure happened while:
Weather conditions at time of exposure:
If there was wind, from what direction was the wind blowing?
Your answer
If there was wind, how strong was the wind?
Did you feel, smell, or taste anything at the time of exposure?
If so, describe what it felt, smelled, or tasted like?
Your answer
What pesticide(s)? (if you know)
Your answer
Describe the exposure: (What happened? Was it a gas, a spray, from a plane, etc.?)
Your answer
Did you see the pesticide being applied? If so, describe how (helicopter, tractor sprayer, etc.) and estimate how far away it was.
Your answer
Who was exposed? (You can give names and contact information, or just describe the number of people, whether children were exposed, etc.)
Your answer
What symptoms did you and others experience?
Me
Others
Dizziness
Headache
Burning eyes
Stomach ache/nausea
Diarrhea
Vomiting
Fainting
Rash/irritation
Onset of asthma attack
Tingling or numbness of skin or mouth
Chemical taste in your mouth, sore throat
Difficulty breathing or shortness of breath
Disorientation or confusion
Allergy-like reaction (sneezing & runny, itchy nose)
If you were exposed at work, did you tell your supervisor?
Did you or do you plan to report this to the County Agricultural Commissioner*? If so, write date & time of call, and what they said to you. *We highly encourage you to report this to the County Agricultural Commissioner. This can be done anonymously. For Monterey County, call 831-759-7325. For Santa Cruz County, call 831-763-8080.
Your answer
Did anyone take pictures*? *Please send any evidence of pesticide drift to Safe Ag Safe Schools at 831-204-8468.
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