Effects of pesticide exposure on public health are monitored in developed countries, which is rare in the least developed countries like Bangladesh. Here, a surveillance study was conducted to investigate the farmer's knowledge and perception toward pesticide use and the impact of occupational exposure as well as an environmental hazard in six agro-based districts (Gazipur, Khulna, Manikganj, Naogaon, Mymensingh, and Tangail) in Bangladesh. A questionnaire was designed for a face-to-face interview of the farmers (at least 100 farmers in each district), and the data was collected. The farmer during cultivations used pesticides as single, double, or several times in a single crop cycle. Among different types of pesticides, insecticides were highly used (38%), whereas Imidacloprid, and Lamda cyhalothrin insecticide was top used by the farmers. Weedicides or herbicides, fungicides, and rodenticides were used at 11%, 48%, and 0.5%, respectively. The knowledge and perception of the farmers towards pesticide usage are minimum, whereas the environmental pollution aspect is deficient. The knowledge of using personal protective equipment is the least. Eighty-five percent of farmers use pesticides by spraying in the field. Thirty-nine percent of farmers suffered from sneezing, burning sensation on face, conjunctivitis, dizziness, and headache during pesticide application, and 3% suffered from skin rash of long time exposed with pesticide. Exposure to pesticides is widespread in the professional life of a farmer in Bangladesh. So, it is essential to ensure different training and awareness-building program for the farmers to cope the adverse situation.