Approved Form
Environmental Protection Act 1994
Agricultural Environmentally Relevant Activities – agricultural chemicals,
fertilisers and soil conditioners application
The purpose of this form is to keep records for agricultural environmentally relevant activities (ERAs) in relation to
agricultural chemicals, fertilisers and soil conditioners applied on agricultural properties in the Great Barrier Reef
catchments: Wet Tropics, Burdekin Dry Tropics and Mackay Whitsundays catchments, under the Environmental Protection
Act 1994 (the EP Act).
This approved form should be used to record the information below within 10 business days after undertaking the
activity/event. References to the Environmental Protection Regulation 2008 (the EP Reg) are also made within this approved
form. It is a requirement of the EP Act that this record be kept for at least five years, and be produced to an officer of the
Department of Environment and Heritage Protection if requested.
Note: if records are kept in another manner that meets all the requirements of this approved form, you do not need to
complete this approved form, and those records will be deemed to be an agricultural ERA record. However, all other record
keeping requirements must be met, including the requirements to make the record within 10 business days after the
activity/event has occurred, and to keep the record for at least five years.
Part 1: Property and contact details
Person responsible for the
agricultural ERA
<INSERT Name>
Company name (if applicable)
<INSERT Name>
Property address
<INSERT Address>
Postal address
<INSERT Address>
Farm identification number (if
applicable)
<INSERT Farm identification number>
Name of person making record
<INSERT Name>
Date of record
<INSERT Date>
Part 2: Records for agricultural chemicals, fertilisers and soil conditioners application (Section 83(2)(a)
of the EP Act)
Product trade name
Method of application (Section 22F(b) of the EP Reg)
<INSERT Name>
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fertigation
surface – broadcast
surface – banded
sub – surface
surface – broadcast and incorporated
Date of application
<INSERT Date>
ABN 46 640 294 485
Approved Form
Agricultural Environmentally Relevant Activities – agricultural chemicals,
fertilisers and soil conditioners application
<INSERT Name>
<INSERT Name>
<INSERT Name>
<INSERT Name>
Page 2 of 6 • 151211 EM1456 Version 1.1
surface – banded and incorporated
aerial
over canopy
under canopy/directed spray
shielded/hooded sprayer
spot spray application
band spraying
<Other - describe:
fertigation
surface – broadcast
surface – banded
sub – surface
surface – broadcast and incorporated
surface – banded and incorporated
aerial
over canopy
under canopy/directed spray
shielded/hooded sprayer
spot spray application
band spraying
<Other - describe:
fertigation
surface – broadcast
surface – banded
sub – surface
surface – broadcast and incorporated
surface – banded and incorporated
aerial
over canopy
under canopy/directed spray
shielded/hooded sprayer
spot spray application
band spraying
<Other - describe:
fertigation
surface – broadcast
surface – banded
sub – surface
surface – broadcast and incorporated
surface – banded and incorporated
aerial
over canopy
under canopy/directed spray
shielded/hooded sprayer
spot spray application
band spraying
<Other - describe:
fertigation
surface – broadcast
>
<INSERT Date>
>
<INSERT Date>
>
<INSERT Date>
>
<INSERT Date>
Department of Environment and Heritage Protection
Approved Form
Agricultural Environmentally Relevant Activities – agricultural chemicals,
fertilisers and soil conditioners application
<INSERT Name>
<INSERT Name>
surface – banded
sub – surface
surface – broadcast and incorporated
surface – banded and incorporated
aerial
over canopy
under canopy/directed spray
shielded/hooded sprayer
spot spray application
band spraying
<Other - describe:
fertigation
surface – broadcast
surface – banded
sub – surface
surface – broadcast and incorporated
surface – banded and incorporated
aerial
over canopy
under canopy/directed spray
shielded/hooded sprayer
spot spray application
band spraying
<Other - describe:
fertigation
surface – broadcast
surface – banded
sub – surface
surface – broadcast and incorporated
surface – banded and incorporated
aerial
over canopy
under canopy/directed spray
shielded/hooded sprayer
spot spray application
band spraying
<Other - describe:
>
<INSERT Date>
>
<INSERT Date>
>
If you need to list additional products, please attach a list to this approved form, providing the same information
as above.
Part 3: Calculation of optimum amounts (Section 83(2)(c) of the EP Act)
Calculated optimum rate of
nitrogen (N) (kg/ha)
<INSERT calculation>
<Date of
calculation>
<INSERT calculation>
<Date of
calculation>
(Section 80(1) of the EP Act)
Calculated optimum rate of
phosphorus (P) (kg/ha)
Page 3 of 6 • 151211 EM1456 Version 1.1
Department of Environment and Heritage Protection
Approved Form
Agricultural Environmentally Relevant Activities – agricultural chemicals,
fertilisers and soil conditioners application
(Section 80(1) of the EP Act)
Part 4: Soil test reports (Section 83(2)(b) of the EP Act)
Name of person conducting
test and their relevant
experience or qualification
<Date of
report>
<INSERT Name>
(Section 81(2) of the EP Act)
Characteristics of the soil
(description)
<INSERT detail>
(Section 81(1)(a) of the EP Act)
Part 5: Property boundaries (Section 22F of the EP Reg)
Please describe the boundaries of the following as maps or diagrams of the relevant agricultural
property: (Note: maps or diagrams may be included in the space below, or attached to this approved form)
1. Crops or paddocks from which soil has been taken for testing; and
2. The areas to which fertilisers or soil conditioners have been applied.
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Department of Environment and Heritage Protection
Approved Form
Agricultural Environmentally Relevant Activities – agricultural chemicals,
fertilisers and soil conditioners application
Page 5 of 6 • 151211 EM1456 Version 1.1
Department of Environment and Heritage Protection
Approved Form
Agricultural Environmentally Relevant Activities – agricultural chemicals,
fertilisers and soil conditioners application
Page 6 of 6 • 151211 EM1456 Version 1.1
Department of Environment and Heritage Protection