Pesticide Exposure Incident Form

Have you been poisoned by pesticides in Oregon?

You have a right to have your pesticide incident investigated by the Oregon Department of Agriculture-Pesticide Division, Pesticide Analytic Response Center and the Oregon Health Authority.

As Oregon’s leading environmental watchdog organization, we collect data on pesticide poisoning and/or pesticide damage incidents for research and to help our members. We want to help you seek justice through regulatory and legislative reform on chemical policies.

More resources for pesticide exposure reporting

Pesticide Exposure Incident Complaint

We will not release your personal information without contacting you first.


For questions about how to fill out this form, feel free to contact Beyond Toxics: / 541-465-8860. Thank you!


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