BACKGROUND Pesticide poisoning is a burning occupational health issue across the world. The pesticide use in the cardamom plantations of Idukki district, Kerala, India is one of the world's highest. However, limited studies addressed its ill effects on the health of pesticide applicators. OBJECTIVE To assess the magnitude of acute pesticide poisoning (APP) among pesticide applicators and understand the nature of severity based on their occupational characteristics. METHODS A descriptive cross-sectional study was conducted in 2018. A total of 300 pesticide applicators with minimum 1-year experience (79.3% males) were selected from 30 randomly selected cardamom plantations in Udumbanchola Taluk. METHODS WHO Field Surveys of Exposure to Pesticides Standard Protocol and Murphy's method of Farmer Self-Surveillance system of pesticide poisoning were used for assessing pesticide exposure and APP, respectively. Statistical analysis used: Descriptive (frequencies) and exploratory statistical analyses (Pearson's Chi-square test) were done using IBM SPSS 23.0. RESULTS The prevalence of APP in this study was 100% as all the pesticide applicators reported at least one sign and/or symptom of APP. The mild APP was more prevalent (80.7%), followed by moderate (18.7) and severe (0.60). Decrease in duration and frequency of spraying, use of motor pump sprayer, safe storage and disposal of pesticides, and proper personal hygiene were found to reduce the severity of APP. CONCLUSIONS All the pesticide applicators in cardamom plantations of Idukki are at risk of APP. It is important to train them about the measures to prevent the same.