Appendix A - Sample forms for fulfilling the requirements of the Healthy Schools Act Warning Sign- P 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the 'Name of Pesticide' in the designated field. Ensure that you provide the exact name as registered.
  3. Next, fill in the 'Name of Manufacturer' to identify who produces the pesticide. This information is crucial for compliance.
  4. Input the 'US EPA Registration No.' which is essential for tracking and regulatory purposes.
  5. Specify the 'Intended Application Date' to inform stakeholders when treatment is planned.
  6. Record the 'Actual Application Date' once treatment has been completed, ensuring accurate documentation.
  7. Provide a brief explanation in the 'Reason for Treatment' section to clarify why this pesticide was applied.
  8. For recordkeeping, enter the 'Amount of Pesticide Used' to maintain compliance with Healthy Schools Act requirements.
  9. Finally, include your contact details under 'For more information about this pesticide application contact:' ensuring that all relevant parties can reach you easily.

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Pesticides include insecticides, insect repellents, miticides, herbicides, fungi cides, fumigants, nematicides, rodenticides, avicides, plant growth regulators, defoliants, desiccants, antimicrobials, and algicides. For more information about antimicrobials (such as sanitizers and disinfectants) see 3-8 and 3-14 below.
Pesticide Application Responsibility The ultimate responsibility for ensuring that pesticide application warning signs are posted before and after applications at a schoolsite primarily lies with the school principal or child care center director.
The California Legislature originally passed the law in 2000. The Healthy Schools Act also encourages schools and child care centerscollectively referred to as schoolsitesto adopt effective, low-risk pest management practices, also known as integrated pest management or IPM.
The schoolsite must report only pesticides applied by schoolsite staff. This includes -killing pesticides. Self-contained bait stations, indoor gel or paste -and-crevice treatments, antimicrobials, and FIFRA 25(b) minimum-risk pesticides are exempt from reporting by schoolsite staff.
Warning Signs. every eCe center must post warning signs around each area where nonexempt pesticides will be applied. these signs should be in place 24 hours before and stay in place 72 hours after pesticides are used.

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All pesticide products, including HSA-exempt products, should still be used as a last resort. HSA-exempt products include: ► Self-contained baits and traps. ► Gels or pastes used for -and-crevice treatments. ► Antimicrobials (products that microorganisms such as sanitizers and disinfectants).
The Healthy Schools Act requires that schools, child care centers, and pest control businesses annually report information about pesticide applications performed by their staff to DPR. For school and child care center staff, there are four specific exemptions to this reporting requirement.

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