This study aimed to determine the feasibility of survey questionnaires for pesticide poisoning. We conducted a pilot study to develop a questionnaire for evaluating pesticide poisoning symptoms and to examine the validity of self-reported information for individual pesticides used. In December 2010 we interviewed 20 farmers with self-reported pesticide poisoning histories residing in Gyeonggi Province. For validity of pesticide information, the purchased pesticide lists from the agricultural cooperative federation were compared with individual self-reported pesticides used. Neurological symptoms were the most common among clinical symptoms related to pesticide poisoning, followed by gastrointestinal, dermal and eye symptoms. Insecticides were the main causative pesticide class for poisoning. Twenty one major symptoms were selected for screening for acute pesticide poisoning in a field study based on the pilot results and literature reviews. Substantial under-reporting was found in data on self-reported individual pesticides used (9.2%), as well as low accuracy (36%) compared with their actual purchase lists. In this pilot study, we suggest the selected symptom lists may apply to a field survey of pesticide poisoning. However, the self-reported information on individual pesticides may not be valid and alternative methods need to be developed.