Self-Assessment module of applicator practices to protect water.

Read all the statements in each set and select the one that best describes your situation. The responses, in order from first to last, have a high, medium, or low (zero or negative) point value. Record the numbers of each of your selections, then add them for your assessment score. Your goal is to score the highest number of points (maximum = 28) .

1.     You have read the Environmental Hazards statement on the pesticide label:

______ Before  beginning an  application (2)

______ Once when the pesticide was purchased (1)

______ Have not read this section of the label (0)

2.     You have developed buffer or set back from an application to protect water:

______ Yes (2)

______ No  (0)

______ Not an option for me  (0)

3.     You have stopped applying a pesticide a safe distance away from water:

______ Yes, always (2)

______ Sometimes (1)

______ No (0)

4.     You use IPM practices when making pesticide application decisions:

______ Always (2)

______ Sometimes, apply pesticides on a schedule in some situations  (1)

______ Never (-1)

5.     Your knowledge of the application site includes groundwater location:

______ Always know how near to the surface groundwater is (2)

______ Sometimes know how near to the surface groundwater is (1)

______ Never know the status of the groundwater of the sites I apply pesticides too (-1)

6.     Your knowledge of the application site includes soil characteristics and leaching potential:

______ Know the soil of all my sites (2)

______ Sometimes know the soil of application sites (1)

______ Never know the soil characteristics of my application sites (-1)

7.     Your mixing and loading site:

______ Is 100 feet or more from wellheads, ditches or other water sources (2)

______ Is between 50 and 100 feet from water sources (1)

______ Is less than 50 feet from water sources (0)

8.     The surface of your mixing and loading site:

______ Is a concrete filling/mixing pad (2)

______ Is a portable impervious spill pad (1)

______ Located on site with no spill containment (-1)

9.     Your spill kit for the mixing/filling site is located:

______ At the mixing /filling site (2)

______ Is close by within 100 feet (1)

______ Don’t have a spill kit near the mixing/filling site (-1)

10.    Your water supply line for filling the tank:

______ Is protected from back flow by an air gap or a check valve (2)

______ Does not have a backflow prevention protection (-1)

11.    Your application device is calibrated:

______ Repeatedly during the season (2)

______ Once each season (1)

______ Has not been calibrated (-1)

12.    You take steps to prevent drift from reaching water sources:

______ Manage all sprayer factors that inhibit drift (2)

______ Manage at least one factor that will inhibit drift (1)

______ Sprayer has no drift control devices (-1)

13.    Your pesticide storage area is:

______ Locked and spill proof (2)

______ One of the two above is true (1)

______ Not locked or spill proof (-1)

14.    Your empty pesticide containers are:

______ Triple rinse and stored securely (2)

______ One of the two above is true (1)

______ Containers are not triple rinsed and are stored outside (-1)