A2Z Services - Pest control

• Client / Site

• Address
  Address

• Date and time

  Date

• Document No.

• Technician name

• Licence number - A500PCO

• Licence number

• Trainee name

• Property type

  Select Domestic Office Health clinic School Commercial Other

  • Domestic
  • Office
  • Health clinic
  • School
  • Commercial
  • Other

• Property description

• Weather conditions

  Select Sunny Dry Cloudy Windy Raining Stormy

  • Sunny
  • Dry
  • Cloudy
  • Windy
  • Raining
  • Stormy

• Temp

• Wind direction

  Select North South East West North East South east South west North west

  • North
  • South
  • East
  • West
  • North East
  • South east
  • South west
  • North west

• Wind speed Beaufort scale

  Select 0 1 2 3 4 5 6

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Beaufort Wind Strength Scale
  You must not spray if the conditions are such that any spray drift or mist may result.
  0 Calm: Still. Smoke rises vertically. < 1.6 km/h.
  1 Light Air: Rising smoke drifts > 1.6 < 4.8 km/h.
  2 Light Breeze: Leaves rustle. You can feel wind on your face. > 6.4 < 11.3 km/h.
  3 Gentle Breeze: Leaves and twigs move. Lightweight flags extend. > 12.9 < 19.3 km/h.
  4 Moderate Breeze: Thin branches move. Paper and dust are raised. > 20.9 < 29.0 km/h.
  5 Fresh Breeze: Moves main branches and smaller trees sway. > 30.6 < 38.6 km/h.
  The EPA considers spraying safely through air in wind stronger than Scale 5 is not possible.
  6 Strong Breeze: Large tree branches move and medium size trees sway. Power lines may whistle. Umbrellas are difficult to control. > 40.2 < 50.0 km/h
  

• Are there moving vehicles about?

• Actual risks - medium
  Struck by moving plant and equipment
  Impeding flow of traffic and interfering with client operations
  Damage to own or other vehicles

• Control measures
  Use high visibility vest
  Park in appropriate areas
  Advise client of presence on site and vehicle location if no designated parking
  Follow traffic rules for site or state or territory

• Have control measures been put in place?

  Yes

  No

• Risk level - Low

• Please ensure control measures are put in place

• Are there any pets or fish on site?

• Actual Risk - Medium
  Poisoning
  Animal attack

• Control measures
  Move any pet food or water bowls
  Cover up fish tanks
  Make self know to client and ask about animals
  Have dogs or cats locked up

• Have control measures been put in place

  Yes

  No

• Risk level - low

• Please ensure control measure are put in place

• Is the client aware you are on site?

• Actual risks - Medium
  Exposure to hazardous situations
  Poor service arising from poor communication
  Damage to own or other vehicles
  Interfering with client operations
  

• Control measures
  Advise client of presence on site and vehicle location if no designated parking
  Display identification
  Sign into site visitors log book and obtain site visitors pass
  

• Have control measures been put in place?

  Yes

  No

• Risk level - Low

• Please ensure control measures are put in place

• Is there the potential for any objects to fall on you?

• Actual risk - medium
  Struck by objects
  Falls and injuries
  Musculoskeletal injuries

• Control measures
  High visibility vest
  Appropriate P.P.E to be worn for the area

• Have control measures been put in place?

  Yes

  No

• Risk level - Low

• Please ensure control measure are put in place.

• Is there the potential for slipping or tripping over items?

• Actual risks - Medium
  Falls and injuries
  Trip on leads and equipment
  slipping on excess liquid
  Musculoskeletal injury
  

• Control Measures
  Appropriate P.P.E to be worn for area
  Sturdy boots in good condition with good grip
  do not place leads or in doorways
  Locate leads and electrical equipment away from walkways
  follow good house keeping
  

• Has any control measures been put in place?

  Yes

  No

• Please ensure control measures are put in place.

• Risk level - Low

• Are you using hazardous substances?

• Actual Risk - Medium
  Spill/chemical contamination and leaks
  Exposure to (Inhalation, absorption, ingestion) hazardous substances
  Spill/chemical contamination and leaks
  Spray drift onto people and property
  Spider/insect bite/sting
  Contamination of water ways

• Control Measures
  Handle according to manufacturers instructions (including the label and M.S.D.S.)
  P.P.E. respirators, elbow length gloves, face shield overalls etc… (refer to product label and M.S.D.S.)
  Wear moisture resistant work boots with adequate grip.
  Mix on level ground, inside bunded areas, away from others
  Replace lid on container
  ALWAYS use back flow prevention device
  ALWAYS have spill response kit available
  Apply according to Treatment Policies (do not over apply)
  Treat according to local environmental conditions
  Substitute to less hazardous chemical
  Advise clients and public of treatments (signage)
  Clean up and advise client of spills
  Plan application to avoid moving under areas just treated.
  

• Have control measures been put in place?

  Yes

  No

• Risk level - Low

• Please ensure control measures are put in place

• Is there the potential for bites or stings?

• Actual Risk - Medium
  Insect bites or stings
  Poising
  Allergic reactions

• Control Measures
  Appropriate P.P.E.(including hard hat) where necessary

• Have control measure been put in place?

  Yes

  No

• Risk Level - Low

• Please ensure control measure are put in place

• Is there any excessive noise about?

• Actual Risk - Medium
  Excessive noise exposure/hearing loss
  

• Control Measures
  Wear correct, well maintained hearing protection where instructed

• Have control measure been put in place?

  Yes

  No

• Risk level - Low

• Please ensure control measure are put in place

• Are you lifting any large or heavy objects?

• Actual Risk - Medium
  Musculoskeletal injury
  Back Strains
  

• Control Measures
  Employ correct lifting policy

• Have control measure been put in place?

  Yes

  No

• Risk Level - Low

• Please ensure all control measure are put in place.

• Are you using electrical equipment?

• Actual Risk - Medium
  Electrocution/electric shock
  
  

• Control Measures
  Follow Testing and Tagging procedures for electrical equipment
  Locate electrical leads and equipment away from walkways. Suspend leads if possible
  Do not place leads in doorways
  Electrical equipment is not to be used in a damp/moist environment
  Locate and isolate all electrical services prior to drilling into walls and floors

• Have control measure been put in place?

  Yes

  No

• Risk Level - Low

• Please ensure control measure are put in place.

• Are you using equipment that can cause vibrations?

• Actual Risk - Medium
  Digestive complications, fatigue, nerve damage, decalcification of carpel tunnel caused by excessive vibration
  

• Control Measure
  Limit exposure to vibrating equipment
  Wear appropriate P.P.E. according to label and M.S.D.S. (respirator, gloves, face shield, hat, overalls, moisture resistant boots etc…)

• Have control measure been put in place?

  Yes

  No

• Risk Level - low

• Please ensure control measure are put in place.

• Are you using any power equipment?

• Actual Risk - Medium
  Excessive noise exposure/hearing loss
  Musculoskeletal injury (back strain etc…)
  Electrocution/electric shock
  Trip on leads and equipment (self and others)
  Excessive noise exposure/hearing loss3
  Digestive complications, fatigue, nerve damage, decalcification of carpel tunnel caused by excessive vibration.
  

• Control Measure
  P.P.E. respirators, elbow length gloves, face shield overalls, Hearing protecting, Hard Hat etc… (refer to product label and M.S.D.S.)
  Employ correct lifting techniques
  Follow Testing and Tagging procedures for electrical equipment
  Locate electrical leads and equipment away from walkways. Suspend leads if possible
  Do not place leads in doorways
  Electrical equipment is not to be used in a damp/moist environment
  Locate and isolate all electrical services prior to drilling into walls and floors
  

• Have control measure been put in place?

  Yes

  No

• Risk Level - low

• Please ensure control measure are put in place.

• Are you working outdoors?

• Actual Risk - Medium\
  Sunburn
  Heat stress
  Dehydration

• Contorl measures
  Application of sunscreen
  always drink Water and limit amount of salty or sweet drinks
  Wear appropriate clothing for outdoor work

• Have control measure been put in place?

  Yes

  No

• Risk Level - low

• Please ensure control measure are put in place.

• Are you using a ladder?

• Actual Risk - Medium
  Falls from height
  Electrocution/electric shock
  Property damage (marking walls and floors)
  Musculoskeletal injury (back strain etc…)

• Control Measure
  Ensure ladder is on firm footing and at 1:4 angle before use
   Use according to any manufacture safety warnings and training
   Do not erect close to stairwells or doorways
   Inspect ladder prior to every use for wear
  Keep away from all electrical wires and electrical equipment
  Not to be used as a work platform. Do not cary equipment on ladder likely to cause instability
  Ensure three points of contact with ladder at all times
  Employ correct lifting techniques

• Have control measure been put in place?

  Yes

  No

• Please ensure control risks are put in place.

• Risk Level low

• Are there any other hazards identified which have not been mentioned?

• Actual Risk

• Control Measures

• Ants

• Warranty 6 months

• Termite Inspection

• Please refer to termite inspection report.

• Termite Treatment

• Please refer to termite treatment report

• Cockroaches

• Warranty - 6 months

• Webbing spiders

• Warranty 6 Months

• Bees and wasps

• Fleas and ticks

• Rodents

• Warranty 6 months

• Silver fish

• Bed Bugs

• Other

• Warranty Period

• Maxxthor

• Activity ingredient: Bifenthrine

• Amount of product used

• Total spray mix applied

• Method of application

• Application rate

• Ultrathor

• Active Ingredient: Fipronil
  

• Amount of product used

• Total spray mix applied

• Method of application

• Application rate

• Ditrac

• Active ingredient: Brodifacoum

• Amount of product used

• Method of application

• Blatathor

• Active ingredient: Abamectin

• Amount of product used

• Mehtod of application

• Deltathor

• Active ingrident: Deltamethrine

• Amount of product used

• Total spray mix applied

• Method of application

• Application rate

• Cyperthor

• Active ingredient: cypermetherine

• Amount of product used

• Total spray mix applied

• Method of application

• Application rate

• Bithor

• Active ingredient: Bifenthrin

• Amount of product used

• Method of application

• Permethor

• Active ingredient: Permethrin

• Amount of product used

• Method of application

• Quick Bayt

• Active ingredient: Imidacloprid

• Amount of product used

• Method of application

• Aerothor

• Active ingrident: IMIPROTHRIN & CYPERMETHRIN

• Amount of product used

• Method of application

• Maxforce Quantum

• Active ingredient: Imidacloprid
  

• Amount of product used

• Method of application

• Battle Axe

• Active ingredient: propoxur & tetramethrin & butoxide

• Amount of product used

• Method of application

• Hymenopthor

• Active ingredient: butoxide

• Method of application

• Amount of product used

• Hand Sprayer

• Honda pump and tank

• Electric duster

• Hand Puffer

• Battery operated sprayer

• Ladder

• Termite inspection kit

• Slab Injector

• Shower rose

• Battery Drill

• Hammer drill

• Pick and shovel

• Mister

• Are there any structural or hygiene requirements for service warranty

Health and Safety Information

• 1. You must advise us of any pets or of any personal or family/staff allergies, or other concerns.
  2. Any persons who are particularly sensitive, or who suffer from allergic reactions, should, as a matter of precaution, remain out of the premises for a period of 24 hours and not return until after the premises have been fully ventilated.
  3. You must remove or protect any people, animals, birds or fish during the treatment period.
  4. You must cover all food items and all food utensils.
  5. You must avoid contact with treated surfaces until the control agent has dried.
  6. You must observe any verbal advice provided by our firm or our licensed operator at the time of treatment.
  7. You must ensure your premises are properly ventilated after treatment. Leave any air-conditioners on 'vent mode' (so they circulate outside air into the building) for a period of at least four hours after the treatment or after re-occupying.
  8. Water Tanks: No treatment can be carried out around water tanks not fully sealed or to water collection areas. You must advise us of water tanks installations.

Details of FREE Service Warranty Period

• 9. Unless specific written arrangements have been provided the full contract price shall be due and payable and recoverable by this Firm.
  10. Any FREE Service Period shall be null and void unless all monies due and payable to this Firm have been paid in full within the standard terms of business above.
  11. Where a FREE Service Period has been provided then, upon notification by you, we agree to provide you with any remedial treatment(s) as may be required to the nominated property, AT NO COST TO YOU. Any FREE Service Period is conditional upon you notifying us of signs of pest infestation. In the case of remote areas, the remedial treatment(s) will be provided free of charge, however travel charges may apply unless the remedial treatment(s) can wait until our firm is within 125km of the location, in which case there will be no travel charges.
  12. No responsibility is accepted, or warranty implied, for any damage or consequential losses that may occur as the result of past, current or future pest activity.
  13. The proposed treatment only applies to the pest species named overleaf on this Pest Management Service Report. The program does not provide protection against any other pest/s.
  14. The remedial treatment(s) only apply if the existing treated infestation is still present. Definition of an infestation: To inhabit or overrun in numbers or quantities large enough to be harmful, threatening, or obnoxious. Up to twelve internal insects located in any one area is not classed as an infestation.
  15. The free service warranty period is NOT conditional on weather activity.
  16. The free service warranty period IS conditional on all structural or hygiene recommendations to client being carried out in full.
  

Treatment Details and Control Agents

• 17. Only control agents approved by the Department of Primary Industry and Energy's Australian Pesticides & Veterinary Medicines Authority (APVMA) and registered for use in the relevant State or Territory or in accord with a Permit issued by APVMA or State Authority will be used.
  18. While every care will be taken, this firm will not be held liable should staining of timbers, fabrics, wall coverings, floor coverings or any other articles occur.
  19. WARNING. Where drilling and or cutting is required; no liability is accepted should damage result to concealed services such as power, gas, water, etc. You indemnify Us against any costs that may arise from such possible damages. Clear and accurate plans should be provided by you before we commence.
  20. You accept that this pest management program can be rendered ineffective if you fail to implement our recommended hygiene procedures, by making building alterations, or by the introduction of conducive or infested materials.

Disclaimer Of Liability To Third Parties

• 22. Compensation will only be payable for loses arising in contract or tort sustained by the client named on the front of this Pest Management Treatment Proposal & Advice Notice. Any third party acting or relying on this Pest Management Treatment Proposal & Advice Notice, in whole or in part, does do so entirely at their own risk.

• Signature

  Sign