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Outhern Nevada District Board of Health P.O. Box 3902, Las Vegas, NV 89127 702.759.1000 Regulations Governing the Sanitation and Safety of Child Care Facilities Appendix D: Pesticide Application Record Form & NRS/NAC 555 for reference REV. 0 Pesticide Application Log Pesticide Application Record for (Name and Address of Child Care Facility): 1. Date of pesticide use 2. Date of prior parent/guardian notification 3. Site, areas, or items treated 4. Brand or Product Name Applied OR Active In.
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