PRODUCT USED (a): ___________;

TO CONTROL (b) ____________

Country: _______________

Date: ______________

Camp: _______________

Name of team leader: __________

Place

Target zone

Treatment
cycle

Dose in g
of a.i./m²

Quantity used
(litres or kg)

Application
methods

Concentration
of formulation
in g/I

Concentration
of formulation
as %

Camp zone

- shelters (blind
- latrines
- garbage bins
- garbage pits
- staff accommodation

Hospitals

- kitchens
- latrines
- garbage bins

Schools

- latrines
- garbage bins

Stores

Drainage areas

- soakpits
- near water sources
- water points

N.B.

(a) = chemical product used and type of formulation [emulsifiable concentrate (EC), wettable powder (WP), etc.]

(b) = target organism