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.

Collection Statement
Personal information is collected for the 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. Collection is authorized under section 4(c) of the Protection of Privacy Act (POPA) and is managed and protected in accordance with the Act. The City intends to input the information into an automated system to generate content or make decisions, recommendations or predictions in accordance with the City of Edmonton Generative AI Standard (see Council Policies, Standards section). For questions about the collection, please contact contact the Melissa Brown, Environmental Manager, 9th Floor, 10111 104 Ave NW, Edmonton, AB T5J 0J4, 780-292-1132.