Pesticide Exposure Incident Report Form

Why Do We Have a Pesticide Incident Complaint Form on the Beyond Toxics web site?

You have a right to have your pesticide poisoning or pesticide damage incident investigated by State of Oregon authorities, namely the Pesticide Analytic Response and the Oregon Health Authority. Beyond Toxics has found that the majority of people who file complaints with the State are dissatisfied with the quality of the investigation itself and questionable professional and ethical conduct on the part of some agency staff. Beyond Toxics is not an agency or State authority but we do collect data on pesticide poisoning or pesticide damage incidents for research and to help our members. We are here to connect you with a growing movement of Oregonians who want redress and legislative reform on chemical policies, and we hope to help you receive a just and respectful response from the agencies you connect with.

More resources for pesticide exposure reporting

Pesticide Exposure Incident Form

Please fill out this form as thoroughly as you can. We will get in touch with you shortly. PART A: Disclosure Approval (below); please check one...
  • Date Format: MM slash DD slash YYYY
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  • Date Format: MM slash DD slash YYYY
  • Please enter a number from 0 to 120.
  • Please include the product name and/or active ingredient. If you have a label, please send us a copy: Beyond Toxics | P.O. Box 1106 | Eugene, OR 97440


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


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