BACKGROUND Farmers are extensively using pesticides for pest control in agriculture. Their precarious handling practices may lead to higher exposure resulting in adverse health effects. OBJECTIVE Current study was aimed to evaluate the knowledge, attitude and practices regarding pesticide usage and its toxic effects by farmers. METHODS Cross sectional. METHODS Rural village in south Karnataka. METHODS Sample size: 171 farmers, Data collection: face to face standardized validated questionnaire. METHODS Chi-square test. RESULTS A total of 118 males and 53 females participated in this study with median age of 40 years. About 61% of the farmers knew the harmful effects of pesticides. However, 22% of them were mixing the pesticides using their bare hands and 26% were not wearing any protective clothing during spraying pesticides. Around 67% were carelessly disposing the leftover pesticides in the open fields. Skin problems and neurological system disturbances were the most common pesticide related health symptoms. Equipment washing practices (P < 0.05) and protective clothing (P < 0.03) were significant predictors of health related problems. Significant associations were found between the occurrence of headache and equipment washing practices (P < 0.03), storage of pesticide remains (P < 0.02) and protective clothing (P < 0.01). CONCLUSIONS These findings showed that knowledge level is adequate among farmers but this did not reflect in their practice. There is a need for continuous pesticide safety education along with training to the farmers regarding use of personal protective devices, personal hygiene and sanitation practices during and after application of pesticides.