Within 48 hours, following completion of treatment, please provide a copy of your pesticide application data using this form.

Before submitting this form, please ensure that the information is correct. Submit one form for each application.
Please note, this data will be included in summary form in the City’s IPM Policy C501A Annual report and will be publically available.

City of Edmonton Project Information

Only @edmonton.ca addresses.

Contractor / Applicator Information

Application Information

Pest Control Information

Where label instructions include dilution, report only the amount of concentrate used.

FOIP Statement

This personal information is being collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act. The City of Edmonton will use this information for purposes necessary to and consistent with administering the Contractor’s Environmental Responsibility Package, implementation of the Integrated Pest Management Policy C501A, and administration of the Pesticide Exemption Program. Personal information in the custody or under the control of the City is protected in accordance with the privacy provisions of FOIP. If you have any questions regarding the collection or use of this information, please contact the Melissa Brown, Environmental Manager, 9th Floor, 10111 104 Ave NW, Edmonton, AB T5J 0J4, 780-292-1132.