DD_1532_Pest_Manage_Report.xlsx

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Submit this spreadsheet on a monthly basis. Complete a separate spreadsheet for each location (base camp, FOB, etc.). Follow this format when naming/saving each spreadsheet: 1532-Country-Base Camp-Month-Year (example: 1532 Afghanistan Bagram Nov 2010.xls). Please refer to the cells above each column header which explains what needs to be filled out for each of the 3 worksheets. Remember to fill out each column and save your work frequently. If you need help filling out this spreadsheet, contact the DoD Pesticide Hotline at:

usarmy.apg.medcom-phc.mbx.pesticide-hotline@mail.mil

Army: NIPRNet:

usarmy.apg.medcom-phc.mbx.pesticide-archival@mail.mil

Navy: (Contingency)

epm@nehc.mar.med.navy.mil

Navy: (Shipboard)

nece-1532-1@med.navy.mil

Air Force:

Through your MAJCOM PMP

Joint Operations:

Submit the spreadsheet to the authority directed by your Theater Command

Changes or recommendations to this Excel spreadsheet should be submitted to: Mr. Zia Mehr

zia.a.mehr.civ@mail.mil

Please complete this worksheet if a pesticide product was applied.

Country

POC/Unit:

Type in the date that the pesticide was applied. The preferred format is YYYY-MM-DD (i.e. 2013-07-22).

The name of the country where the pesticide was applied should automatically populate based on the selection made in the "Country" cell above.

Type in the current name of the base camp where the pesticide was applied.

Select the specific site of application from the drop down list where the pesticide was applied (i.e. bldg #, activity name, etc.) . If the site is not listed, please type in the site of application.

Select the origin for why the pesticide was applied from the drop down list (i.e. work order, etc.).

Select the type of operation performed from the drop down list (i.e. Exterior Bait).

Select a target pest that you were attempting to manage/control from the drop down list (i.e. Rodents). If the target pest isn't listed, then write the target pest in the additional comments field.

Type in the size of the area treated (i.e. 100).

Select the appropriate units of measure (i.e. square feet, meters, acres, etc.) related to the area treated from the drop down list.

Select the Environmental Protection Agency Registration Number (EPA Reg. No. on product label) of the pesticide applied from the drop down list (i.e. 12455-79). If the number doesn't appear, please go to the worksheet called "New Pesticides Applied" to manually enter the EPA Registration Number.

If the EPA Registration Number is selected, the pesticide trade name will automatically populate in this column (i.e. CONTRAC All-Weather Blox).

If the EPA Registration Number is selected, the product formulation will automatically populate in this column (i.e. Pelleted/Tabletted).

If the EPA Registration Number is selected, the active ingredient percentage for the product will automatically populate in this column (i.e. 0.005).

Type in the amount of concentrate used for mixing. If the product does not require mixing and is ready to be used please select "N/A".

Select the appropriate units of measure related to the amount of concentrate from the drop down list (i.e. ounce, pound, etc.). If the product does not require mixing and is ready to be used please select "N/A".

Type in the Final % Concentration in the Finished Product. If the product does not require mixing and is ready to be used please select "N/A".

Type in the amount of finished product applied. For products that are formulated as Aerosols, please indicate the number of can(s) used. This estimate will be useful in calculating the total Pounds of Active Ingredient (PAI) applied.

Select the appropriate units of measure related to the amount of finished product applied from the drop down list (i.e. ounce, pound, etc.).

Type in the name of the person (i.e. John Doe) who applied the pesticide.

Type in the applicator's DoD FIFRA, DoD Non-FIFRA, or State Certification Number.

Type in the exact time in which the pesticide was applied at the site. The preferred format is hh:mm (i.e. 09:45).

Type in the total time invested by all applicators in the operation in hours (i.e. 1 or 0.5).

Provide any additional comments.

Date

Country

Base Camp

Site of Application

Origin

Operation

Target Pest

Area Treated

Units of Measure for the Area Treated

EPA Registration Number

Pesticide Trade Name

Product Formulation

Active Ingredient Percentage

Amount of Concentrate Used for Mixing

Units of Measure for the Amount of Concentrate Used for Mixing

Final % Concentration in Finished Product

Amount of Finished Product Applied

Units of Measure for the Amount of Finished Product Applied

Applicator Name

Applicator Certification #

Time Pesticide was Applied

Total Time Invested in Hours

Additional Comments

Please complete this worksheet if the EPA Registration Number of the pesticide product applied was not found in the dropdown list of the Pesticides Applied worksheet.

Country

POC/Unit:

Type in the date that the pesticide was applied. The preferred format is YYYY-MM-DD (i.e. 2013-07-22).

The name of the country where the pesticide was applied should automatically populate based on the selection made in the "Country" cell above.

Type in the current name of the base camp where the pesticide was applied.

Select the specific site of application from the drop down list where the pesticide was applied (i.e. bldg #, activity name, etc.) . If the site is not listed, please type in the site of application.

Select the origin for why the pesticide was applied from the drop down list (i.e. work order, etc.).

Select the type of operation performed from the drop down list (i.e. Exterior Bait).

Select a target pest that you were attempting to manage/control from the drop down list (i.e. Rodents). If the target pest isn't listed, then write the target pest in the additional comments field.

Type in the size of the area treated (i.e. 100).

Select the appropriate units of measure (i.e. square feet, meters, acres, etc.) related to the area treated from the drop down list.

Type in the Environmental Protection Agency Registration Number (EPA Reg. No. on product label) of the pesticide applied (i.e. 12455-79).

Type in the pesticide trade name (i.e. CONTRAC All-Weather Blox).

Type in the product formulation (i.e. Pelleted/Tabletted).

Type in the active ingredient(s) listed on the product label (i.e. Bromadiolone).

Type in the active ingredient percentage listed on the product label (i.e. 0.005).