Incident Report

Subform I: General Information

1. Report Type.

Update the report

Incident Report Number: 2012-1681

2. Registrant Information.

Registrant Reference Number: xx

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

3. Select the appropriate subform(s) for the incident.

Environment

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

08-APR-12

Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.

Active(s)

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: Dekalb seed

• Active Ingredient(s)
  • CLOTHIANIDIN

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: Pionner seed

• Active Ingredient(s)
  • THIAMETHOXAM

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: x

• Active Ingredient(s)
  • FLUVALINATE-TAU

---

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: corn seed

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Inspected by Health Canada Pest Mgt. Progrm, ENE, and OMAFRA on April 17.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Terr. Invrtbrt-Honey Bee/Inv.Ter-Abeille

2. Common name(s)

Honey Bee

3. Scientific name(s)

Unknown

4. Number of organisms affected

Unknown

5. Description of site where incident was observed

Fresh water

Terrestrial

Agricultural

Salt Water

6. Check all symptoms that apply

Death

7. Describe symptoms and outcome (died, recovered, etc.).

A corn field planted approx 200 meters North of hives on April 5. North field planted with Pioneer Seed (treated with thiamethoxam). Bee keeper noticed a sweet smell on April 6. April 7 was warmer (approx 17C). Noticed significant bee kill on April 8. A second field of corn planted approx 400 meters South of hives on April 13. South field planted with Dekalb seed (treated with clothiandin). Second bee kill noticed on April 13. Corn planted by (name) (city) (province) with large Case-IH Air Seeder. Talc powder (seed lubricant) is added to seed at approx 3 cups to 50 bu. seed. Sample of dead bees and sample of seed obtained by ENE on April 17.

8. a) Was the incident a result of (select all that apply)

Unknown

8. b) i) How many times has the product been applied this year?

Unknown

8. b) ii) What was the date of the last application?

Unknown

9. Did it rain

9. a) During application?

Unknown

9. b) Up to 3 days after application?

Unknown

10. a) Was there a buffer zone?

Unknown

10. b) What type?

Aquatic

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

Yes

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

13. Please provide supplemental information here