Pest Control Service Form

Pest Control Service Record

Name of Company

License No

Address

Date

What Pests Were Found

Reason Pests Were Found

Steps Taken to Eliminate Pests

Name & Quantity of Pesticide(s) Used

Method of Pesticide Application & Equipment Used

Application Site (Where was the pesticide applied)

On-site Verification Completed By

Verification Date

Record Verification Completed By

Record Verification Date