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. Aim: Current study was aimed to evaluate the knowledge, attitude and practices regarding pesticide usage and its toxic effects by farmers. Settings and Design: Cross sectional, Study Setting: Rural village in south Karnataka. Materials and Methods: Sample size: 171 farmers, Data collection: face to face standardized validated questionnaire. Statistical Analysis: 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). Conclusion: 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.