South Dakota Administrative Rules
Title 12 - Department of Agriculture
Article 12:56 - Pesticides
Chapter 12:56:06 - Damage claims
Section 12:56:06:01 - Contents of report form for alleged pesticide incident

(1) name and address of person making the report;

(2) telephone number of person making the report;

(3) County and legal description of property where incident occurred or damage is alleged;

(4) Date, approximate time, weather conditions including wind direction, and temperature when application was made, if known:

(5) County and legal description of property on which application was made;

(6) Operator of property where application was made;

(7) Description of incident or damages;

(8) Name of applicator or operator applying pesticides;

(9) Name of witness, if known;

(10) Whether ground or aerial application; crop treated;

(11) Chemical used, if known; if the applicator was notified and, if so, when; and

(12) The date the incident form was submitted and the signature of the person completing the form.