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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

Update the report

Incident Report Number: 2012-3131

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. The pesticide was applied: unknown. The conditions at the time of planting were dusty and quite cool, and the crop was planted unknown distance from the beeyard.

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 2012-05-22; a bee sample was collected on 2012-04-28. There were 4 hives in the bee yard, with 4 hives showing mortality. The estimated number of dead bees per colony was: 1 hive = 1000s of dead bees still recovering; 3 hives=100s of dead bees OK now. The observed symptoms were: Observed a couple of days after seeding and only saw dead bees. Colongy condition weakened in 3, very very weak in fourth. Condition prior to incident was excellent, two supers already. The state of the colony afterwards was unknown.Reported to RAPB May 17, sample not picked up until May 23. beekeeper took a sample on May 3. Located at edge of bushland at back of farm but within cash crop and dairy farming area. Usual farm setup with bushland to the back of the property. A creek flows through our property in addition there is a pond. lake and are ~4km away to the NE. ~ 4 km away to the SW. A Union Gas pipe line runs along the southern border of our farm. Land has a slight roll in this area. There are flowering plants along some hedge rows, along roadways and in the margins of bush areas. Closest water source 10m, colonies have been at this location for 20yrs.

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