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| WVDA Worker Protection Standard Inspection Report |
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WEST VIRGINIA DEPARTMENT OF AGRICULTURE

Gus R. Douglass, Commissioner

 

Site Name: ________________________________________________             Date: ______________________________________ 

Address: __________________________________________________           Time: ______________________________________

 

 

WORKER PROTECTION STANDARD INSPECTION REPORT

A.    CENTRAL NOTIFICATION

        1. Is the site easily accessible to workers/handlers prior to beginning of workday? Y/N 

        2. Are the EPA-approved safety posters displayed? Y/N 

        3. Is emergency information displayed and accurate? Y/N 

        4. Is pesticide application information posted? Y/N 

        5. Is the following information contained in the posted application records:

            a. Location of area treated? Y/N 

            b. Product name? Y/N

            c. Active ingredient? Y/N

            d. EPA registration number? Y/N

            e. Time and date of application? Y/N

        6. Does the pesticide information remain posted for 30 days following REI? Y/N 

B.    DECONTAMINATION

        1. Are handler decontamination sites supplied with clean water, soap, disposable towels and clean coveralls? Y/N

        2. Does handler have decontamination sites at the mix/load area, within 1/4 mile of the application site and where PPE is removed? Y/N

        3. Is the decontamination site provided for the duration of the handling activity? Y/N

        4. Is 1 pint eyeflush water or equivalent immediately available to handlers and early  entry workers? Y/N 

        5. If label requires protective eyewear, what is expiration date? _________

        6. Are worker decontamination sites supplied with clean water, soap, and single use disposable towels? Y/N

        7. Are worker decontamination sites within 1/4 mile of the work site? Y/N

        8. Are decontamination sites provided for workers until 30 days following the expiration of the REI? Y/N

C.    TRAINING

        1. Are all workers/handlers/trainers certified pesticide applicators or have WPS handler training? Y/N

        2. Do handlers receive training before loading, mixing or applying pesticides? Y/N

        3. Are handlers informed of labeling and have access to labels? Y/N

        4. Do workers receive training before the 5th day of entry into treated areas? Y/N

        5. Do early entry workers receive required additional training? Y/N

        6. Who does the training? _____________________________ # _________________

        7. Is training presented in a language the trainees can understand? Y/N

D.    ENTRY RESTRICTIONS

        1. Has early-entry during agriculture emergencies been approved by WVDA? Y/N

E.    INFORMATION

        1. Has your custom applicator provided you with required information for posting at central notification prior to application? Y/N

        2. Do you provide information to the custom applicator about REI's in effect on your property? Y/N

F.    NOTICE OF APPLICATIONS:

        1. When required on the label, are both oral and posted warning given? Y/N

        2. Are oral warnings given clearly and in a language the workers can understand? Y/N

        3. Posted requirements:

            a. Is an EPA approved sign being used? Y/N

            b. Is the sign put up no more than 24 hours prior to application? Y/N

            c. Does the sign come down within 3 days of the end of REI? Y/N

            d. Is the sign posted at a primary worker points of entry to the treated area? Y/N

G.    PERSONAL PROTECTIVE EQUIPMENT:

        1. Is required PPE provided to handlers and early-entry workers? Y/N

        2. Are persons instructed in the proper use of the PPE? Y/N

        3. Is PPE inspected before each day's use? Y/N

        4. Are cleaning/maintenance requirements of PPE met? Y/N

        5. Is a cleaning place provided for PPE storage? Y/N

        6. Have those cleaning PPE received special instructions? Y/N

H.    EMERGENCY ASSISTANCE:

        1. Is transportation made available to any employee who becomes sick or is injured by pesticides? Y/N

        2. Are provisions made to supply information about the pesticide to medical personnel? Y/N

I.    APPLICATION RESTRICTIONS AND MONITORING OF HANDLERS:

        1. Are pesticides applied so that no one, other than appropriately trained and equipped handlers, are exposed? Y/N

        2. Is sight or voice contact made at least every 2 hours with the handler using a pesticide that bears the skull and crossbones? Y/N

 

Exit interview comments or suggestions:

 

 

Regulatory Officer _____________________________________________________________________

 
Owner/Operator/Agent 
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