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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-3011

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: X

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


4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.


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.


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

Product Name: x

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


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

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

corn planted approx 2 weeks prior to bee kill. The conditions were coolish and overcast the day bee kills observed, and the crop was planted 1500 meters from the beeyard. Mite treatment in fall 2011 included Thymol. No mite treatment in spring 2012. Corn planted aprrox 2 weeks prior to bee kill. 30-APR-12 hives were ok, coolish and overcast on May 1 (day dead bees observed). There was a sprayer in one of fields nearby, high boy sprayer - the crop was corn

To be determined by Registrant

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


Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

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

2. Common name(s)

3. Scientific name(s)

4. Number of organisms affected


5. Description of site where incident was observed

Fresh water



Salt Water

6. Check all symptoms that apply

Abnormal behavioural effects


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

Bee mortality was observed on 2012-05-01 and was visited on 2012-05-03; a bee sample was collected 2012-05-03. There were 30 hives in the bee yard, with 30 hives showing mortality. The estimated number of dead bees was 300-400 per strong hive, 100 dead bees per weak hive (approx total estimate 9000 at yard). The observed symptoms were they laynig flat out, bees were carrying other dead bees in front of the hive, odd one was staggering around, The state of the colony afterwards was as of July 24, they are slow coming back, some have come back alright, others are slow to build up, only the last 3 weeks where they have come, lost queens this year (7 or 8) - they seemed to disappear, noticing the absence of eggs and larvae.

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


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


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


9. Did it rain

9. a) During application?


9. b) Up to 3 days after application?


10. a) Was there a buffer zone?


10. b) What type?


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

11. a) Were environmental samples collected and analysed?


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