Treatment

date

Record keeping template

Product trade name

No. of hives
treated

Volume of gas
tight fumigation
room or tarp
covered space

Location of apiary or
beekeeping equipment

Quantity of
product
used

Treatment
application
rate

Name and address of

applicator

Treatment of bees or beekeeping equipment with agricultural and veterinary chemicals

Broodmix (pre-mix)

50

100 Nectar Road, Bendigo

5 kg

100 g/hive

J Beekeeper 10 Hive St,

EXAMPLEVILLE VIC 3999

30/09/12

Tetracin 100 Soluble Powder

(to be mixed with caster
sugar)

100

11 Pollen Track, Walpeup

1 kg

100 g/hive

J Beekeeper 10 Hive St,

EXAMPLEVILLE VIC 3999

30/09/12

Fumitoxin coated insecticide

tablets

30 supers

24 Propolis Way, Echuca

54 tablets

3 tablets/2 cubic
metres

J Beekeeper 10 Hive St,

EXAMPLEVILLE VIC 3999

30/09/12

Unleaded petrol

25

16 Honey Street, Ellinbank

6.25 L

250 mL/hive

J Beekeeper 10 Hive St,

EXAMPLEVILLE VIC 3999

30/09/12

36 cubic metres

Always read the label before using any chemical product

Oxytetracycline hydrochloride (OTC) is the active constituent of the registered veterinary
chemical product Broodmix and is a Prescription Animal Remedy (S4) drug and must be
prescribed by a registered veterinarian
Fumitoxin coated insecticide tablets are a S7 chemical and must only be used by persons
holding a current Agricultural Chemical User Permit (ACUP)

Agricultural and veterinary chemical product details must be recorded within 48 hours of use
Records must be kept for two years
Note: This template recognises the chemical applicator as the owner or an employee of the owner. If the applicator
is not the owner or their employee (i.e. person for whom the application was carried out), please record the owners
name and address (note that a Commercial Operators Licence (COL) is required if this is the case)
This template meets the requirements under the Agricultural and Veterinary Chemicals (Control of Use) Regulations
2007 and is a guide only
For details of your legal requirements when using agricultural chemicals visit: www.depi.vic.gov.au/chemicaluse

Treatment
date

Record keeping template

Product trade name

No. of hives
treated

Volume of gas
tight fumigation
room or tarp
covered space

Location of apiary or
beekeeping equipment

Quantity of
product
used

Treatment
application
rate

Name and address of

applicator

Treatment of bees or beekeeping equipment with agricultural and veterinary chemicals

Always read the label before using any chemical product

Oxytetracycline hydrochloride (OTC) is the active constituent of the registered veterinary
chemical product Broodmix and is an Prescription Animal Remedy (S4) drug and must be
prescribed by a registered veterinarian
Fumitoxin coated insecticide tablets are a S7 chemical and must only be used by persons
holding a current Agricultural Chemical User Permit (ACUP)

Agricultural and veterinary chemical product details must be recorded within 48 hours of use
Records must be kept for two years
Note: This template recognises the chemical applicator as the owner or an employee of the owner. If the applicator
is not the owner or their employee (i.e. person for whom the application was carried out), please record the owners
name and address (note that a Commercial Operators Licence (COL) is required if this is the case)
This template meets the requirements under the Agricultural and Veterinary Chemicals (Control of Use) Regulations
2007 and is a guide only
For details of your legal requirements when using agricultural chemicals visit: www.depi.vic.gov.au/chemicaluse