Pest Control Inspection Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Site

• Building/Area

  Select House Apartment/Unit Store Restaurant Factory School/Daycare Hospital/Nursing Home

  • House
  • Apartment/Unit
  • Store
  • Restaurant
  • Factory
  • School/Daycare
  • Hospital/Nursing Home

Service Type

• Warranty/No Charge

• One Time Treatment

• Weekly

• Bi-Weekly

• Monthly

• Bi-Monthly

• Quarterly

• Yearly

Pest Treated

• Cockroaches

  Select German American Oriental Other

  • German
  • American
  • Oriental
  • Other

• Rodents

  Select Mice Rats

  • Mice
  • Rats

• Ants

  Select Pharaoh Black Carpenter Ghost Other

  • Pharaoh
  • Black
  • Carpenter
  • Ghost
  • Other

• Bees

  Select carpenter Yellow Jacket Other

  • carpenter
  • Yellow Jacket
  • Other

• Spiders

  Select Garden House Cellar Other

  • Garden
  • House
  • Cellar
  • Other

• Wasps

  Select Mud Dauber Paper Other

  • Mud Dauber
  • Paper
  • Other

• Fleas

  Yes

  No

  N/A

• Mosquitoes

  Yes

  No

  N/A

• Silverfish

  Yes

  No

  N/A

• Other

Treatment Area(s)

• Interior

  Select Kitchen Bathroom Living Room Dining Bedroom Basement Attic Other

  • Kitchen
  • Bathroom
  • Living Room
  • Dining
  • Bedroom
  • Basement
  • Attic
  • Other

• Exterior

  Select Perimeter Fence Line Stump Nest Garden Other

  • Perimeter
  • Fence Line
  • Stump
  • Nest
  • Garden
  • Other

Chemical Used

• Advion Roach Gel EPA Reg # 352-652 0.6% Indoxacarb

• Advion Ant Gel EPA Reg # 352-746 0.05% Indoxacarb

• Temprid SC EPA Reg # 432-1483 21.00% Imidacloprid 10.50% Beta-Cyfluthrin Glycerine

• Contrac Blox EPA Reg # 12455-79 0.005% Bromadiolone

• Glue Boards/Monitor Traps

Guarantee

• None

• 30 Day

• 60 Day

• 90 Day

• 1 Year

• Other

Sanitation

• Overall Sanitation

  Good

  Fair

  Poor

Comments/Recommendations

IDPH Licenses

• 051-027332

• 052-082047